Abstract
BackgroundTo investigate the long-term outcome of trabeculotomy and to compare it with that of trabeculectomy.MethodsWe retrospectively reviewed the medical records of patients who had undergone standalone trabeculotomy. Inclusion criteria included a follow-up period of at least 6 years, availability of reliable static visual field results, etc. Age- and preoperative intraocular pressure -matched trabeculectomy cases served as controls. A Kaplan-Meier analysis was employed as a measure of surgical success. Additional clinical factors were also analyzed.ResultsTwenty-five eyes of 25 trabeculotomy patients and 20 eyes of 20 trabeculectomy patients with a mean postoperative follow-up period of 8.0 years were selected. The Kaplan-Meier analysis estimated that the success probability defined as intraocular pressure < 16 mmHg was 44.0 ± 9.9% and 75.0 ± 9.7% at 6 years for trabeculotomy and trabeculectomy, respectively. The final mean deviation significantly progressed in trabeculotomy cases in Central 30–2 programs of the Humphrey Field Analyzer (P = 0.025). Patient characteristics and postoperative clinical data were analyzed by Mann-Whitney’s U test and Wilcoxon signed-rank test.ConclusionsWhile trabeculotomy was inferior to trabeculectomy in terms of intraocular pressure control and visual field stability in our series, surgical indications should always be determined on an individual basis, pending further research.
Highlights
To investigate the long-term outcome of trabeculotomy and to compare it with that of trabeculectomy
Patient selection and surgical procedures We reviewed the medical records of all patients who had undergone standalone trabeculotomy at Gifu University Hospital between June 2004 and December 2010, and who fulfilled the following selection criteria: 1. primary open- angle glaucoma (POAG); 2. aged younger than 70 years old at the time of surgery; 3. no prior intraocular surgeries conducted; 4. followed at least 6 years; 5. best-corrected visual acuity of at least 20/25; 6. spherical equivalent of the refractive error greater than − 8.0D; 7
The Kaplan-Meier analysis based on criterion A (IOP < 21 mmHg) estimated that the probability of successful intraocular pressure (IOP) control was 72.0 ± 9.0% and 85.0 ± 8.0% at 6 years for the trabeculotomy group and the trabeculectomy group, respectively (Fig. 2a)
Summary
To investigate the long-term outcome of trabeculotomy and to compare it with that of trabeculectomy. The most common surgical techniques for management of glaucoma are filtering surgery and outflow channel surgery focused on Schlemm’s canal. Trabeculotomy is an outflow channel surgery first reported by Burian and Smith in 1960. Harms subsequently modified the technique, employing a scleral flap to more identify Schlemm’s canal in 1970, which further popularized the surgery. There are many reports of good intraocular pressure (IOP) control via trabeculotomy in open- angle glaucoma, including childhood glaucoma, steroid-induced glaucoma, and exfoliation glaucoma [1,2,3,4]. The procedure is mainly indicated in younger patients, in eyes with higher IOP, or in eyes with milder glaucomatous changes. Trabeculotomy is characterized by incising the trabecular meshwork that is believed to play a role
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