Abstract
Background
The minimally invasive ab-interno trabeculectomy (AIT) via electro-ablation with the Trabectome has been on the European market since 2009. Many studies have proven the safety and efficacy of the procedure. Up until now, studies investigating the long-term effect of AIT have been sparse. In this study, we present long-term results of AIT in patients with primary and secondary open-angle glaucoma.
Methods
In a retrospective monocentric study, the data of all the patients having undergone the procedure in 2010 at our institution were recorded. Data was collected during routine examinations at our institution. In total, 81 eyes of 74 patients (46 patients with primary open-angle glaucoma (POAG), 28 patients with pseudoexfoliative glaucoma (PEXG)) were included. At every examination, the intraocular pressure (IOP) was measured using Goldmann applanation tonometry and the number of IOP-lowering medication was registered. Statistical analysis was done using the Kaplan-Meier analysis or Dunnett’s t test, respectively.
Results
For both groups (POAG and PEXG), we found a significant lowering of the IOP (28% for POAG and 26% for PEXG) and a significant reduction of the number of IOP-lowering medication (32% for POAG and 29% for PEXG) after a median follow-up period of 3.5 years.
Conclusion
In patients with open-angle glaucoma and especially pseudoexfoliative glaucoma, ab-interno trabeculectomy is an effective surgical procedure to significantly lower the intraocular pressure on a long-term basis.
Similar content being viewed by others
References
Quigley HA, Broman AT (2006) The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol 90:262–267. https://doi.org/10.1136/bjo.2005.081224
Tham Y-C, Li X, Wong TY et al (2014) Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology 121:2081–2090. https://doi.org/10.1016/j.ophtha.2014.05.013
Kass MA, Heuer DK, Higginbotham EJ et al (2002) The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol Chic Ill 1960 120:701–713 discussion 829-830
Garway-Heath DF, Crabb DP, Bunce C et al (2015) Latanoprost for open-angle glaucoma (UKGTS): a randomised, multicentre, placebo-controlled trial. Lancet Lond Engl 385:1295–1304. https://doi.org/10.1016/S0140-6736(14)62111-5
Shaarawy T, Grehn F, Sherwood M, World Glaucoma Association (2009) WGA guidelines on design and reporting of glaucoma surgical trials. Kugler Publications, The Hague
Cairns JE (1968) Trabeculectomy. Preliminary report of a new method. Am J Ophthalmol 66:673–679
Kwong A, Law SK, Kule RR et al (2014) Long-term outcomes of resident- versus attending-performed primary trabeculectomy with mitomycin C in a United States residency program. Am J Ophthalmol 157:1190–1201. https://doi.org/10.1016/j.ajo.2014.02.028
Klink T, Kann G, Ellinger P et al (2011) The prognostic value of the Wuerzburg bleb classification score for the outcome of trabeculectomy. Ophthalmol J Int Ophtalmol Int J Ophthalmol Z Augenheilkd 225:55–60. https://doi.org/10.1159/000314717
Landers J, Martin K, Sarkies N et al (2012) A twenty-year follow-up study of trabeculectomy: risk factors and outcomes. Ophthalmology 119:694–702. https://doi.org/10.1016/j.ophtha.2011.09.043
Tektas O-Y, Lütjen-Drecoll E (2009) Structural changes of the trabecular meshwork in different kinds of glaucoma. Exp Eye Res 88:769–775. https://doi.org/10.1016/j.exer.2008.11.025
Wecker T, Jordan JF (2015) Minimalinvasive Kammerwinkelchirurgie mit dem Trabektom. Klin Monatsblätter Für Augenheilkd 232:303–309. https://doi.org/10.1055/s-0034-1383014
Kaplowitz K, Bussel II, Honkanen R et al (2016) Review and meta-analysis of ab-interno trabeculectomy outcomes. Br J Ophthalmol 100:594–600. https://doi.org/10.1136/bjophthalmol-2015-307131
Mosaed S (2014) The first decade of global Trabectome outcomes. Eur Ophthalmic Rev 08:113. https://doi.org/10.17925/EOR.2014.08.02.113
Esfandiari H, Shah P, Torkian P et al (2018) Five-year clinical outcomes of combined phacoemulsification and trabectome surgery at a single glaucoma center. Graefes Arch Clin Exp Ophthalmol Albrecht Von Graefes Arch Klin Exp Ophthalmol. https://doi.org/10.1007/s00417-018-4146-y
Jordan JF, Wecker T, van OC et al (2013) Trabectome surgery for primary and secondary open angle glaucomas. Graefes Arch Clin Exp Ophthalmol 251:2753–2760. https://doi.org/10.1007/s00417-013-2500-7
Wickham H (2007) Reshaping data with the reshape package. J Stat Softw 21:1–20
Wickham H (2009) ggplot2: elegant graphics for data analysis. Springer, New York
Wickham H (2011) The split-apply-combine strategy for data analysis. J Stat Softw 40:1–29
R Core Team (2014) R: a Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna
Ting JLM, Damji KF, Stiles MC, Trabectome Study Group (2012) Ab interno trabeculectomy: outcomes in exfoliation versus primary open-angle glaucoma. J Cataract Refract Surg 38:315–323. https://doi.org/10.1016/j.jcrs.2011.08.043
Ahuja Y, Ma Khin Pyi S, Malihi M et al (2013) Clinical results of ab interno trabeculotomy using the trabectome for open-angle glaucoma: the Mayo Clinic series in Rochester, Minnesota. Am J Ophthalmol 156:927–935.e2. https://doi.org/10.1016/j.ajo.2013.06.001
Pahlitzsch M, Gonnermann J, A-KB M et al (2015) Trabekulotomie ab interno (Trabectome) – Kumulierte klinische Ergebnisse eines großen Glaukomkollektivs. Klin Monatsblätter Augenheilkd 232:1198–1207. https://doi.org/10.1055/s-0041-105941
Werth JP, Gesser C, Klemm M (2015) Unterschiedliche Effekte der Trabektomoperation auf unterschiedliche Glaukomformen. Klin Monatsblätter Augenheilkd 232:72–78. https://doi.org/10.1055/s-0034-1383010
Pahlitzsch M, Davids AM, Zorn M et al (2018) Three-year results of ab interno trabeculectomy (Trabectome): Berlin study group. Graefes Arch Clin Exp Ophthalmol Albrecht Von Graefes Arch Klin Exp Ophthalmol 256:611–619. https://doi.org/10.1007/s00417-017-3882-8
Funding
No funding was received for this research.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Conflict of interest
The authors declare that they have no conflict of interest.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Avar, M., Jordan, J.F., Neuburger, M. et al. Long-term follow-up of intraocular pressure and pressure-lowering medication in patients after ab-interno trabeculectomy with the Trabectome. Graefes Arch Clin Exp Ophthalmol 257, 997–1003 (2019). https://doi.org/10.1007/s00417-019-04259-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-019-04259-5