Abstract
BackgroundTrabeculotomy with the Trabectome® is an effective surgical procedure to lower intraocular pressure (IOP). However, in some patients it does not lead to a significant IOP reduction despite a gonioscopically well visible opening of Schlemm’s canal. This study investigated whether the size of the trabeculotomy opening and other parameters, including anterior chamber depth (ACD) are related to IOP reduction.MethodsRetrospective observational case series with 93 eyes of 93 patients who underwent Trabectome surgery. Trabeculotomy opening and ACD were measured with an anterior segment swept source OCT. IOP was taken pre-operatively and at a single follow-up visit [follow-up time 125 ± 66 days (mean ± SD)]. The relationship between IOP reduction and OCT parameters and possible confounding factors was analyzed in a multiple linear regression model.ResultsThe trabeculotomy opening size did not correlate with IOP reduction (slope of regression line = 0.0016; 95% confidence interval of slope: −0.025 to 0.028). The same applied for all other parameters tested, including ACD, which showed a tendency towards better IOP reduction with a deeper AC (slope = −1.9; 95% confidence interval: −5.54 to 1.73). Comparison between the 1st and 4th quartile of the trabeculotomy opening showed a significantly higher ACD in the largest trabeculotomy opening quartile (3.32 ± 0.05 mm vs. 3.16 ± 0.04 mm; p = 0.031).ConclusionsThe fact that the trabeculotomy opening size did not correlate with IOP reduction points to the poorly understood role of the intrascleral aqueous outflow pathway in glaucomatous IOP elevation. A deeper AC might be a factor promoting a larger trabeculotomy opening.
Highlights
Various morphological and functional alterations of the trabecular meshwork (TM) are known to increase aqueous outflow resistance in open-angle glaucoma [1, 2]
The fact that the trabeculotomy opening size did not correlate with intraocular pressure (IOP) reduction points to the poorly understood role of the intrascleral aqueous outflow pathway in glaucomatous IOP elevation
In this retrospective observational case series, we investigated the relationship between the size of the post-operative trabeculotomy opening after Trabectome surgery and the resulting IOP reduction
Summary
Various morphological and functional alterations of the trabecular meshwork (TM) are known to increase aqueous outflow resistance in open-angle glaucoma [1, 2]. Trabectome surgery has been proven a safe and effective procedure to significantly lower intraocular pressure (IOP) in open-angle glaucoma patients [4,5,6]. After 2 years of follow-up, a total of approximately 20 to 40% of all cases (depending on glaucoma type and lens status) fail to develop a significantly lower IOP [8]. Some of these failed cases still exhibit a Graefes Arch Clin Exp Ophthalmol (2017) 255:1643–1650 gonioscopically well visible opening of Schlemm’s canal which may indicate an impaired function of the outflow structures distal to Schlemm’s canal, comprising collector channels and the aqueous vein plexus [9]. This study investigated whether the size of the trabeculotomy opening and other parameters, including anterior chamber depth (ACD) are related to IOP reduction
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