Trabeculotomy Ab Research Articles

Trabeculotomy (ab externo) as primary intervention for open-angle glaucoma : 5-year results

The published results of trabeculotomy ab externo (TOT), as an outflow channel surgery in adults with open-angle glaucoma, are underrepresented in comparison with other pressure-lowering glaucoma procedures. To determine the long-term pressure lowering effect and complications of TOT as astand-alone procedure or in combination with phacoemulsification with intraocular lens implantation (PIT) as aprimary pressure-lowering procedure in adult patients with forms of chronic open-angle glaucoma. This was aretrospective analysis of 121 eyes of 106 patients wherby 90eyes underwent TOT and 31eyes underwent PIT. The follow-up period was 5years. Follow-up was performed in the same center under standardized conditions. Preoperative as well as postoperative best-corrected distance visual acuity, intraocular pressure, pressure-lowering medication, and complications were recorded. For success criterion1, the intraocular pressure was not allowed to exceed 17 mm Hg at any control. For success criterion2, the intraocular pressure was allowed to be above 17 mm Hg at 1 control throughout the follow-up period. Preoperative intraocular pressure in the TOT group was 25.92 mm Hg (SD 6.58) and 26.32 mm Hg (SD 6.06) in the PIT group. The annual cumulative success rates with pressure-lowering medications for success criterion1 were 92.8%, 82.5%, 70.5%, 52.7% and 26.1%. For success criterion2 these were 97.9%; 94.9%, 93.2%, 91.3%, and 89%. We found no relevant difference in pressure reduction between TOT and PIT. Without pressure-lowering medications, success rates were significantly lower for both success criteria. No serious complications occurred. The most common postoperative complication was spontaneously resorbable hyphema. Performing TOT or PIT as aprimary glaucoma procedure for chronic open-angle glaucoma in adults is reasonable, has a significant pressure-lowering effect and very low complication rate.

Comparison of Short-term Visual Acuity Changes After Trabeculotomy ab Interno Using Trabectome and Trabeculectomy ab Externo

To compare short-term visual acuity (VA) changes after trabeculotomy ab interno (TAI) using trabectome and trabeculectomy ab externo (TAE) performed on pseudophakic eyes. A single-center retrospective study. Patients with pseudophakic eyes who had primary open-angle glaucoma or exfoliation glaucoma and underwent TAI or TAE alone. Changes in intraocular pressure (IOP), medication score, Snellen VA, and the number of eyes with vision loss (loss of ≥ 2 Snellen lines) were evaluated at baseline, week 1, and months 1, 3, and 6. The risk factors for vision loss at 6 months postoperatively were analyzed in both groups. Visual acuity changes. A total of 112 eyes of 112 patients were examined: 46 in the TAI group and 66 in the TAE group. Intraocular pressure was significantly lower in both groups at each visit than at baseline. The TAI group had a significantly higher mean postoperative IOP than the TAE group. Medication scores in the TAI group were significantly different after 3 months compared with baseline; however, decreased significantly at all study visits in the TAE group. The mean VA in the TAI group did not decrease significantly at each visit. In the TAE group, it decreased significantly up to 3 months but was not significantly different at 6 months. At all study visits, the number of eyes with vision loss was significantly lower in the TAI group than in the TAE group. Only 2 eyes in the TAI group (4.3%) had vision loss at 6 months, which was caused by macular edema. In the TAE group, 13 eyes (19.7%) experienced vision loss at 6 months. In all cases, the presence of preoperative split fixation [odds ratio=7.30, P<0.05] and the occurrence of hypotony-related complications [odds ratio=6.76, P<0.05] within 6 months were risk factors for vision loss. TAI lowered IOP less than TAE; however, there was less vision loss with TAI. For eyes with a target IOP in the mid-teens, TAI can be recommended as initial surgery. Proprietary or commercial disclosuremay be found in the Footnotes and Disclosures at the end of this article.

Approach to primary congenital glaucoma: A perspective.

Primary congenital glaucoma (PCG) occurs worldwide and has a broad range of ocular manifestations. It poses a therapeutic challenge to the ophthalmologist. A proper diagnostic evaluation under anesthesia is advisable for all children who do not cooperate for an office examination. Medical therapy only serves as a supportive role, and surgical intervention remains the principal therapeutic modality. Angle incision surgery such as goniotomy or trabeculotomy ab externo is the preferred choice of surgery in the Caucasian population. Primary combined trabeculotomy-trabeculectomy with or without antifibrotic therapy is the preferred choice in certain regions such as India and the Middle East where the disease usually presents with severe forms of corneal edema along with megalocornea. In refractory cases, trabeculectomy with antifibrotic therapy or glaucoma drainage devices are available options in the armamentarium. Cycloablative procedures should be reserved for eyes with poor visual potential. Myopia is common among children with PCG, and appropriate optical refractive correction in the form of glasses or contact lenses should be provided. Amblyopia therapy should be instituted to ensure overall visual development in the early developmental years. Low-vision rehabilitation services should be provided to children with vision impairment. Long-term follow-up is mandatory and carers of children with PCG should be counseled and educated about this need. Regardless of the visual outcomes, clinicians should emphasize the need for education of these children during the clinic visit. The overall goal of the management should be to improve the overall quality of life of the children with PCG and their carers.

Suture trabeculotomy ab interno for secondary glaucoma in Japanese patients with Val30Met hereditary transthyretin amyloidosis

We retrospectively evaluated surgical outcomes of suture trabeculotomy (SLOT) ab interno for secondary glaucoma in 18 eyes of 12 patients with hereditary transthyretin (ATTRv) amyloidosis with Val30Met mutation. SLOT ab interno was performed between May 2015 and January 2020. All the participants were followed up for at least 12 months. The primary outcome measure was Kaplan–Meier survival. Failure of this treatment was defined as an intraocular pressure (IOP) of ≥ 22 mmHg and a < 20% IOP reduction with or without medication or as additional operations needed to reduce IOP. The mean postoperative follow-up period was 3.5 years (1.2–6.1 years). The SLOT ab interno procedure alone was performed in 17 eyes (94%). Fifteen eyes (83%) had a 360° incision made in Schlemm’s canal and 3 eyes (17%) had a 180° incision performed. Cumulative survival values were 0.83, 0.63, and 0.22 at 1, 2, and 3 years, respectively. Ten eyes (56%) needed additional surgery, such as repeated SLOT ab interno, Ahmed glaucoma valve implantation, or MicroPulse transscleral cyclophotocoagulation. Our results here, as well as our previous results with trabeculectomy, suggest that SLOT ab interno may not have a sufficiently long-term effect on secondary glaucoma because of ATTRv amyloidosis.

“Coming up short” with an illuminated microcatheter for circumferential trabeculotomy ab externo in the buphthalmic infant eye: frequency and options

Angle surgery constitutes initial surgical treatment for most primary congenital glaucoma (PCG) cases. An illuminated microcatheter (iTrack microcatheter/Nova Eye Medical, Fremont, CA) facilitates circumferential trabeculotomy (360trab) but may not “reach” 360° in buphthalmic PCG eyes. This study’s purpose is the creation and validation of a model using preoperative horizontal corneal diameter (HCD) to predict whether the iTrack will traverse all 360° of Schlemm canal (SC) to assist surgical planning.

Canaloplasty and Trabeculotomy Ab Interno Combined with Cataract Surgery: 12-Month Outcomes in Hispanic Patients with Open-Angle Glaucoma.

Canaloplasty and Trabeculotomy Ab Interno Combined with Cataract Surgery: 12-Month Outcomes in Hispanic Patients with Open-Angle Glaucoma.

Bilateral Congenital Glaucoma – A Rare Case Report

Background: Glaucoma in childhood is a potentially blinding condition, yet, there is a lack of epidemiologic and clinical data regarding this pathology. Unlike glaucoma in adults, which is notoriously difficult to detect since there are no symptoms, glaucoma in children does present with signs and symptoms which can be detected by paediatricians and even parents, who are usually the first contacts of these children. Methodology: A detailed evaluation under general or local anaesthesia is advisable to establish the diagnosis and plan for management. Medical therapy has a limited role and surgery remains the primary therapeutic modality. While goniotomy or trabeculotomy ab externo is valuable in the management of congenital glaucoma, primary combined trabeculotomy–trabeculectomy offers the best hope of success in advanced cases. Result: The childhood glaucoma research network (CGRN) has provided a new classification system of paediatric glaucoma’s. Careful diagnosis and timely intervention leads to the most promising outcome and gives these children a long morbidity free life. Early diagnosis, prompt therapeutic intervention and proper refractive correction are keys to success. Conclusion: Management of residual vision and visual rehabilitation should be an integral part of the management of children with low vision and lifelong follow-up is a must.

Comparison of effectiveness and complications in trabeculotomy with phacoemulsification between ab externo and ab interno using a spatula-shaped microhook

To compare the short-term surgical effectiveness and safety profile of trabeculotomy ab externo and ab interno with microhook in terms of the recovery of visual acuity. A retrospective chart review was performed on patients who underwent trabeculotomy combined with phacoemulsification and lens implantation at Asahi General Hospital, with 6 months of follow-up. The patients treated by trabeculotomy were classified into two groups depending on the surgical procedures: ab interno with Tanito microhook (TMH) and ab externo with rigid probe trabeculotome (LOT). The demographics, preoperative and postoperative intraocular pressure (IOP), number of medications (Med), best-corrected visual acuity (BCVA), surgical-induced astigmatism (SIA), and postoperative complications were analyzed at pre-operation, and 1 week and 1–6 months post-operation. Fifty-two eyes of 38 Japanese patients underwent TMH and 42 eyes of 32 patients underwent LOT. The decreases in IOP and Med from the baseline were significant at all time points in both groups (p < 0.001), but there were no significant differences between the two groups. BCVA improved significantly in TMH and LOT after the operation (p < 0.001). BCVA and SIA significantly improved, mostly at 1 week in TMH, compared with LOT (p = 0.02 and 0.003). Hyphema and IOP spike exceeding 30 mmHg (spike) occurred in 11% and 6% of participants in TMH, and 33% and 26% of participants in LOT, respectively. Hyphema and IOP spike occurred more frequently in the LOT than in the TMH group (p = 0.01 and 0.005). Ab interno trabeculotomy showed similar IOP-lowering effects as ab externo, but had less postoperative complications.

One-year outcomes of microhook trabeculotomy versus suture trabeculotomy ab interno

PurposeTo compare clinical success rates and reductions in intraocular pressure (IOP) and IOP-lowering medication use following suture trabeculotomy ab interno (S group) or microhook trabeculotomy (μ group).MethodsThis retrospective review collected data from S (n = 104, 122 eyes) and μ (n = 42, 47 eyes) groups who underwent treatment between June 1, 2016, and October 31, 2019, and had 12-month follow-up data including IOP, glaucoma medications, complications, and additional IOP-lowering procedures. The Kaplan–Meier survival analysis was used to evaluate treatment success rates defined as normal IOP (> 5 to ≤ 18 mm Hg), ≥ 20% reduction of IOP from baseline at two consecutive visits, and no further glaucoma surgery.ResultsSchlemm’s canal opening was longer in the S group than in the μ group (P < 0.0001). The Kaplan–Meier survival analysis of all eyes showed cumulative clinical success rates in S and µ groups were 71.1% and 61.7% (P = 0.230). The Kaplan–Meier survival analysis of eyes with preoperative IOP ≥ 21 mmHg showed cumulative clinical success rates in S and μ groups were 80.4% and 60.0% (P = 0.0192). There were no significant differences in postoperative IOP at 1, 3, and 6 months (S group, 14.9 ± 5.6, 14.6 ± 4.5, 14.6 ± 3.9 mmHg; μ group, 15.8 ± 5.9, 15.2 ± 4.4, 14.7 ± 3.7 mmHg; P = 0.364, 0.443, 0.823), but postoperative IOP was significantly lower in the S group at 12 months (S group, 14.1 ± 3.1 mmHg; μ group, 15.6 ± 4.1 mmHg; P = 0.0361). There were no significant differences in postoperative numbers of glaucoma medications at 1, 3, 6, and 12 months (S group, 1.8 ± 1.6, 1.8 ± 1.5, 2.0 ± 1.6, 1.8 ± 1.5; μ group, 2.0 ± 1.6, 2.0 ± 1.6, 2.1 ± 1.6, 2.2 ± 1.7; P = 0.699, 0.420, 0.737, 0.198).ConclusionS and µ group eyes achieved IOP reduction, but μ group eyes had lower clinical success rates among patients with high preoperative IOP at 12 months.

Canaloplasty and trabeculotomy ab interno with the OMNI system combined with cataract surgery in open-angle glaucoma: 12-month outcomes from the ROMEO study.

To provide safety and effectiveness outcomes 12 months postsurgically for sequential canaloplasty and trabeculotomy with the OMNI system combined with cataract surgery in mild-to-moderate open-angle glaucoma (OAG). Eleven ophthalmology practices and surgery centers located in 8 U.S. states. Retrospective, multicenter, single arm. Twelve surgeons contributed 81 patients meeting eligibility criteria: OAG, 12-month follow-up, and medicated intraocular pressure (IOP) 36 mm Hg or less on 4 or less medications preoperatively. Analysis was stratified by baseline IOP: more than 18 mm Hg (Group 1) and 18 mm Hg (Group 2) or less. Success was defined as proportion with 20% reduction or greater in IOP or IOP between 6 and 18 mm Hg (inclusive) and on the same or fewer medications without secondary surgical intervention (SSI). Other endpoints included mean IOP and medications at 12 months. Safety included corrected distance visual acuity and adverse events (AEs). Of the 81 patients included, primary success was met by 79% in Group 1 and 81% in Group 2. The mean IOP was reduced in Group 1 (21.9 to 15.1 mm Hg, P < .0001) and remained controlled in Group 2 (14.1 to 13.4 mm Hg, P = .3177). Medications went from 2.0 ± 1.3 to 1.1 ± 1.1 in Group 1 and from 1.6 ± 1.3 to 0.9 ± 1.2 in Group 2. AEs were typical for cataract or angle surgery: mild inflammation (11%), IOP spikes (5%), and hyphema (4%). Four patients (5%) required an SSI. The OMNI system provided effective IOP reduction, sustained IOP control, and meaningful medication reduction for up to 12 months postoperative.

Combined Circumferential Canaloplasty and Trabeculotomy Ab Interno with the OMNI Surgical System

In the normal eye the conventional outflow pathway is responsible for the majority of aqueous humor egress and plays a key role in the maintenance of healthy intraocular pressure. However, in the glaucomatous eye pathologic changes to the pathway in the trabecular meshwork, Schlemm’s canal, and collector channel ostia can introduce abnormal resistance to outflow with consequent increase in intraocular pressure. The OMNI Surgical System (Sight Sciences, Menlo Park, CA USA) is a relatively new surgical device and the only one that combines two ab interno minimally invasive treatments in a single procedure, canaloplasty and trabeculotomy. This new technology allows surgeons to address outflow resistance wherever it may be, both proximally (juxtacanalicular trabecular meshwork and inner wall of Schlemm’s canal), and distally (Schlemm’s canal and the collector channels). This review covers several recent clinical studies of the OMNI device with the aim of collating what is known and what remains to be learned.

Combined cataract surgery and goniotomy-assisted 360-degree suture trabeculotomy in a 14-year-old boy

Combined cataract and angle surgery potentially eliminates a second surgical setting, further anesthesia, and an additional recovery period, but it can pose intraoperative challenges for the surgeon. The authors demonstrate cataract extraction and 360-degree suture trabeculotomy ab externo with the added challenged of decreased ocular rigidity. Schlemm’s canal was cannulated for 360° with a 6-0 polypropylene suture that was left in place until completion of cataract extraction, limited anterior vitrectomy, and intraocular lens implantation through a scleral tunnel. Transluminal suture was unable to be advanced into the anterior chamber by applying traction on the suture ends. This maneuver, while typically effective in noncombined cases, distorted the scleral tunnel and allowed fluid and viscoelastic device to exit the anterior chamber. Ultimately, trabeculotomy was completed by performing goniotomy of one quadrant under direct visualization, allowing a starting point for transluminal suture to incise the remainder of the trabecular meshwork.

Effects of Ripasudil on Open-Angle Glaucoma after Circumferential Suture Trabeculotomy Ab Interno.

We evaluated the effects of ripasudil on the distal aqueous outflow tract in patients with open-angle glaucoma (OAG) who underwent a 360° suture trabeculotomy ab interno followed by ripasudil treatment beginning 1 month postoperatively. We compared 27 of these patients, by using propensity score analysis, with 27 patients in a matched control group who had no ripasudil treatment. We assessed the changes in the mean intraocular pressure (IOP) and the relationship between the IOP changes and background factors. All eyes had a complete 360° Schlemm’s canal incision and phacoemulsification. The mean IOP at 1 and 3 months after ripasudil administration were significantly reduced by −1.7 ± 1.9 mmHg (p < 0.0001) and −1.3 ± 2.3 mmHg (p = 0.0081) in the ripasudil group, respectively, but IOP in the control group was not significantly reduced. The IOP reduction was significantly associated with the IOP before ripasudil treatment (p < 0.001). In conclusion, the use of ripasudil for patients with OAG after circumferential incision of the Schlemm’s canal produced significant IOP reductions. Ripasudil may affect the distal outflow tract, thereby leading to the IOP reduction.

Comparison of 12-month surgical outcomes of ab interno trabeculotomy with phacoemulsification between spatula-shaped and dual-blade microhooks.

To compare 12-month clinical results of spatula-shaped and dual-blade microhooks ab interno trabeculotomy with phacoemulsification. Retrospective comparative study. We conducted a retrospective chart review of Japanese open-angle glaucoma patients who underwent ab interno trabeculotomy with phacoemulsification with a 12-month follow-up. Two types of trabecular hook were used: the spatula-shaped Tanito Trabeculotomy ab interno Micro-hook® and the Kahook Dual Blade®. Changes in intraocular pressure (IOP) and medication scores comprised the main outcome metrics. We also analyzed and compared patient demographics and the occurrence of complications. Trabeculotomy was performed using a spatula-shaped hook in 17 eyes and a dual-blade hook in 15 eyes. Significant reductions in IOP (p < 0.001) and medication scores (p < 0.001) were noted in both groups after the 1-month time point. The percentage changes of IOP from baseline at each time point were not significantly different between groups, though there was a significant difference in medication scores at 12months (p = 0.0192). Postoperative complications occurred similarly in both groups; one case in the dual-blade group required additional filtration surgery. Ab interno trabeculotomy with phacoemulsification was effective in lowering IOP both with spatula-shaped and with double-blade microhooks. At 12months more medications were used postoperatively in the spatula-shaped microhook group; however, the reductions in the medication scores from baseline were statistically significant in both groups.

Ирригационная микротрабекулотомия ab interno в комбинированной хирургии глаукомы и катаракты

Ирригационная микротрабекулотомия ab interno в комбинированной хирургии глаукомы и катаракты

Turn Back Elevation of Once Reduced IOP After Trabeculotomy Ab Externo and Kahook Dual Blade Surgeries Combined with Cataract Surgery.

PurposeTo evaluate the surgical outcome of internal trabeculectomy by Kahook dual blade (KDB) with that of external trabeculotomy, each combined with phaco-lensectomy and intraocular lens implantation (Phaco).Patients and MethodsThis is a retrospective comparative study. The primary and secondary outcome measures are postsurgical intraocular pressure and postsurgical hyphema. One eye each of 76 primary open angle glaucoma (POAG), pseudoexfoliation glaucoma (PEG) and ocular hypertension (OH) patients underwent external phaco-trabeculotomy, and that of 40 POAG, PEG and OH patients underwent phaco-KDB surgery.ResultsReduction of the intraocular pressure (IOP) by phaco-KDB at one and two years was 28.4 and 27.8%, respectively, and was not significantly different from that by external phaco-trabeculotomy of 32.7% (P=0.256) and 31.5% (P=0.468), respectively. Three months postsurgical IOP after phaco-KDB and external phaco-trabeculotomy was 16.1 and 15.9 mmHg, respectively. There was a significant turn back elevation of once reduced IOP to 17.1 (P=0.0207) and 17.0 mmHg (P=0.0096) at 24 months, respectively. There were no differences in success probability to achieve IOP below 17 mmHg (P=0.120), 21 mmHg (P=0.719) and >20% IOP reduction (P=0.309) with medication(s) at two years between the phaco-KDB and external phaco-trabeculotomy cohorts. Younger age was a significant (P<0.001) risk factor for failure; however, presurgical IOP (P=0.466), the type of surgery (P=0.219) and presence of postsurgical IOP spike (P=0.737) were not significant risk factors by the Cox proportional hazard model. Hyphema and spike of the IOP in phaco-KDB and external phaco-trabeculotomy cohorts were 40% and 88% (P<0.001), and 53% and 41% (P=0.238), respectively.ConclusionThe IOP reduction by the phaco-KDB was equivalent to that by external phaco-trabeculotomy up to two years. In both cohorts, once reduced postsurgical IOP tend to increase up to 24 months.

12-month randomised trial of 360° and 180° Schlemm’s canal incisions in suture trabeculotomy ab interno for open-angle glaucoma

Background/AimsTo perform a 12-month comparison between the different extents and locations of Schlemm’s canal incisions during suture trabeculotomy ab interno for open-angle glaucoma (OAG).MethodsThis is a prospective, single-centre, three-arm randomised...

A comparison of the 1-year surgical outcomes of ab externo trabeculotomy and microhook ab interno trabeculotomy using propensity score analysis

ObjectiveTo compare the 1-year outcomes of trabeculotomy ab externo (ab externo TLO) and trabeculotomy ab interno using a microhook (ab interno TLO) for glaucoma patients using propensity score analysis.Methods and...

Circumferential canal surgery: a brief history.

Purpose of reviewMost microinvasive glaucoma surgery (MIGS) procedures bypass outflow resistance residing proximally in the trabecular meshwork and inner wall of Schlemm's canal. A novel procedure combining trabeculotomy with viscodilation adds to this by also addressing distal resistance of the canal and collector channel ostia. This review examines the development and evidence for both trabeculotomy and canaloplasty separately and the combination in a single procedure.Recent findingsRecent aqueous angiography studies have confirmed the segmental nature of outflow through Schlemm's canal highlighting the need to address distal outflow pathway resistance. Combined trabeculotomy and viscodilation ab interno is a novel approach with a new purpose-designed device (OMNI Surgical System) becoming available to surgeons in early 2018. Recent results as both a standalone and combined with cataract procedure demonstrate significant intraocular pressure reductions with an average 41% reduction from baseline in the pseudophakic group.SummaryTargeting both distal as well as proximal points of outflow resistance in the conventional pathway may prove to be a highly efficacious MIGS modality. Additional large prospective studies are currently ongoing to confirm these preliminary results.

Отдаленные результаты трабекулотомии ab interno в хирургии глаукомы и катаракты

Purpose. To study long-term results of combined surgery for glaucoma and cataract by trabeculotomy ab interno. Material and Methods. 62 patients (64 eyes) with combination of glaucoma and cataract. The age of patients is from 53 to 84 years. The initial stage of glaucoma - 10 eyes, developed - 33 eyes, far-advanced - 21 eyes, level of intraocular pressure (IOP) before surgery in all eyes was intolerant for these stages of glaucoma and ranged from 21 to 36 mmHg. Indications for surgical treatment were absence of persistent IOP level compensation in hypotensive mode, the presence of lens opacification, which affects central visual acuity (VA). Best corrected VA is from 0.01 to 0.6. The technique of combined surgery included: 1st stage - phacoemulsification with implantation of flexible IOL; 2nd stage - trabeculotomy ab interno. The observation period is 18 months. Results. During the observation period of up to 18 months, IOP decreased on average to 20.8±3.1 mmHg. The target level of IOP without an additional antihypertensive regimen remained in 22 eyes (34.37%), with antihypertensive regimen - in 42 eyes (65.63%). In most patients VA increased to 0.2–1.0 and only in 2 cases decreased due to development of posterior capsular fibrosis. Conducting trabeculotomy ab interno has significantly reduced number of drugs used. However, 3-12 months after surgery, IOP increase up to 26-30 mmHg was observed in 4 eyes with antihypertensive drug regimen; microinvasive non-penetrating deep sclerectomy was performed to compensate for it. Conclusion. Trabeculotomy ab interno in combination with phacoemulsification with IOL implantation was effective and safe operation. Sufficient hypotensive effect and high visual functions observe at 18 months observation period.