close
Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2013 Dec;251(12):2753-60.
doi: 10.1007/s00417-013-2500-7. Epub 2013 Oct 26.

Trabectome surgery for primary and secondary open angle glaucomas

Jens F Jordan  1 , Thomas Wecker, Christian van Oterendorp, Alexandra Anton, Thomas Reinhard, Daniel Boehringer, Matthias Neuburger
Affiliations
Observational Study

Trabectome surgery for primary and secondary open angle glaucomas

Jens F Jordan et al. Graefes Arch Clin Exp Ophthalmol. 2013 Dec.

Abstract

Purpose: In most forms of open angle glaucoma, the trabecular meshwork is the main barrier for aqueous humor outflow, causing elevated intraocular pressure (IOP). The Trabectome is a minimal invasive device for the surgical treatment of open angle glaucoma, particularly eliminating the juxtacanalicular meshwork. This study was conducted to compare the effectiveness and complication profile among different glaucoma subgroups.

Methods: Single center prospective observational study. There were 557 consecutive eyes of 487 patients included in this study. Trabectome surgery was performed either alone or in combination with cataract surgery. Intraoperative and postoperative complications were documented systematically. Main outcome measures were IOP reduction over time and the preoperative and postoperative number of IOP-lowering medications. Due to subgroup sizes, only data from eyes with primary open angle glaucoma and pseudoexfoliation glaucoma were processed for statistical analysis.

Results: For the 261 eyes classified as primary open angle glaucoma, preoperative IOP was 24 ± 5.5 mmHg (mean ± SD) under 2.1 ± 1.3 IOP-lowering medications. After a mean follow-up of 204 ± 238 days, IOP was reduced to 18 ± 6.1 mmHg, and medication was reduced to 1.2 ± 1.1. For the 173 eyes classified as pseudoexfoliation glaucoma, after a mean follow-up of 200 ± 278 days, IOP was reduced from 25 ± 5.9 mmHg to 18 ± 8.2 mmHg, and medication was reduced from 2.0 ± 1.2 to 1.1 ± 1.1. A Cox proportional hazards model hinted forward superiority of the combined surgery cases (Trabectome + Phaco + intraocular lens) in comparison to Trabectome surgery only in phakic or pseudophakic eyes. No serious complications were observed.

Conclusions: Minimal invasive glaucoma surgery with the Trabectome seems to be safe and effective. The subgroup analysis of different kinds of open angle glaucomas presented in this study may help in first-line patient selection. The lack of ocular surface alterations makes it a valuable addition to glaucoma surgery.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
a Absolute success: Kaplan-Meier cumulative survival of all eyes classified as Primary Open Angle Glaucoma (POAG) or Pseudoexfoliation Glaucoma (XFG) over time, absolute success (ΔIOP ≥ -20 % from baseline, no additional IOP lowering medication). Please note the steep drop of the Kaplan-Meier curve for both, POAG and XFG, resembling the persistent need for topical medication after Trabectome surgery in most eyes. b Qualified success: Kaplan-Meier cumulative survival of all eyes classified as Primary Open Angle Glaucoma (POAG) or Pseudoexfoliation Glaucoma (XFG) over time, qualified success ((ΔIOP ≥ -20 % from baseline, topical medication allowed). The difference between the two groups was significant at p = 0.01
Fig. 2
Fig. 2
a Postoperative IOP data (ordinate [mmHg]) over time (abscissa [days after surgery]) from eyes classified as POAG, given separately for the eyes being phakic or pseudophakic at the time of Trabectome surgery, and for the eyes having undergone combined cataract and Trabectome surgery. Time ‘0’ gives the preoperative IOP value. N (below abscissa) gives the number of patients included at each time point. b Qualified success: Number of postoperative topical medications needed (ordinate [n]) over time (abscissa [days after surgery]) from eyes classified as POAG, given separately for the eyes being phakic or pseudophakic at the time of Trabectome surgery, and for the eyes having undergone combined cataract and Trabectome surgery. Time ‘0’ gives the preoperative number of topical medications
Fig. 3
Fig. 3
a Postoperative IOP data (ordinate [mmHg]) over time (abscissa [days after surgery]) from eyes classified as XFG, given separately for the eyes being phakic or pseudophakic at the time of Trabectome surgery, and for the eyes having undergone combined cataract and Trabectome surgery. Time ‘0’ gives the preoperative IOP value. N (below abscissa) gives the number of patients included at each time point. b Qualified success: Number of postoperative topical medications needed (ordinate [n]) over time (abscissa [days after surgery]) from eyes classified as XFG, given separately for the eyes being phakic or pseudophakic at the time of Trabectome surgery, and for the eyes having undergone combined cataract and Trabectome surgery. Time ‘0’ gives the preoperative number of topical medications
See this image and copyright information in PMC

References

    1. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006;90:262–267. doi: 10.1136/bjo.2005.081224. - DOI - PMC - PubMed
    1. Minckler D, Mosaed S, Dustin L, Ms BF. Trabectome (trabeculectomy-internal approach): additional experience and extended follow-up. Trans Am Ophthalmol Soc. 2008;106:149–159. - PMC - PubMed
    1. Mosaed S, Rhee DJ, Filippopoulos T, Tseng H, Deokule S, Weinreb RN. Trabectome outcomes in adult open-angle glaucoma patients: One-year follow-up. Clin Surg Ophthalmol. 2010;28:5–9.
    1. Ting JLM, Damji KF, Stiles MC. Ab interno trabeculectomy: Outcomes in exfoliation versus primary open-angle glaucoma. J Cataract Refract Surg. 2012;38:315–323. doi: 10.1016/j.jcrs.2011.08.043. - DOI - PubMed
    1. Jea SY, Mosaed S, Vold SD, Rhee DJ. Effect of a failed trabectome on subsequent trabeculectomy. J Glaucoma. 2012;21:71–75. - PubMed

Publication types

LinkOut - more resources