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IOP-lowering and drug-sparing effects of trabectome surgery with or without cyclodialysis ab interno

  • Glaucoma
  • Published:
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Abstract

Purpose

To compare the postoperative intraocular pressure (IOP) after ab interno trabeculectomy (AIT; trabectome surgery) alone or combined with cyclodialysis ab interno (AITC).

Patients and methods

Forty-three eyes with insufficiently controlled open-angle glaucoma were included in this consecutive case series. All eyes received AIT, combined with phacoemulsification and IOL-implantation in phakic instances, with or without additional cyclodialysis ab interno. Postoperative visual acuity, IOP, number of IOP-lowering medications and complications were registered over 12 months.

Results

A total of 19 eyes (14 patients) received AIT and 24 (19 patients) received AITC. Both groups were comparable for baseline IOP (AIT: 19.7 ± 8.2 mmHg; AITC: 19.4 ± 6.8 mmHg; p = 0.96), there was a comparable IOP reduction after 6 months (AIT: − 3.8 ± 12.3, median (interquartile range (IQR)): − 3.8 (− 7.8–4.8) mmHg; AITC: − 4.9 ± 8.3, median (IQR): − 2.0 (− 10.8–2.0) mmHg; p = 0.95) and 12 months (AIT: − 4.3 ± 6.6, median (IQR): − 4.0 (− 8.0 to − 1.0) mmHg; AITC: − 3.7 ± 6.7, median (IQR): − 1.5 (− 5.5 to − 0.5) mmHg; p = 0.49). While final visual acuity was similar between the groups, they differed regarding topical IOP-lowering medications (baseline: AIT 2.9 ± 1.2 and AITC 2.9 ± 1.2; 1 year after surgery: AIT 2.6 ± 1.5 (p = 0.16) and AITC 1.3 ± 1.3; p < 0.001)). Depending on the definition, a complete or qualified success of 33.4–45.8% was achieved in AITC compared to 15.8–21.1% in AIT.

Conclusion

The additional suprachoroidal outflow when AIT is combined with cyclodialysis ab interno (AITC) seems to result in an additional drug sparing effect for at least 1 year without critical safety signals. Thus, AITC might be further investigated prospectively prior to advocating its use in routine minimally invasive glaucoma surgery.

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Data availability

Data are available on request by contact of the corresponding author.

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Acknowledgements

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Author information

Authors and Affiliations

  1. Berner Augenklinik, Zieglerstrasse 29, CH-3007, Bern, Switzerland

    Richard A. Garweg, Isabel B. Pfister, Christin Schild, Kim Straessle, Stefano Anastasi & Justus G. Garweg

  2. Swiss Eye Institute, Rotkreuz, Switzerland

    Richard A. Garweg, Isabel B. Pfister, Christin Schild, Kim Straessle, Stefano Anastasi & Justus G. Garweg

  3. Department of Ophthalmology, University of Bern, Bern, Switzerland

    Richard A. Garweg & Justus G. Garweg

  4. Augenärzte Flums, Marktstrasse 21, 8890, Flums, Switzerland

    Markus Halberstadt

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Contributions

RAG substantially contributed to the acquisition and interpretation of the data and was a major contributor in writing the manuscript. IBP substantially contributed to the acquisition and analyses as well as interpretation of the data and was a contributor in writing the manuscript. CS substantially contributed to the acquisition of the data. MH, KS, and SA contributed to data check, statistical interpretation and manuscript writing. JGG substantially contributed to the conception and design of the work, data acquisition, interpretation of the data and was a key contributor in writing the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Justus G. Garweg.

Ethics declarations

Ethical approval

This study was approved by the Ethics Committee of the canton Berne (registration number 2021–01341) based on the informed consent of all included patients to use their coded data for this retrospective analysis and performed in accordance with the International Council for Harmonisation E6 Good Clinical Practice Guideline, the 1964 Declaration of Helsinki and its later amendments, and federal laws.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. JGG acts as advisor and speaker for several pharmaceutical companies and contributes to several international industry-sponsored clinical studies in the fields of retinal disease and uveitis (AbbVie, Bayer, Novartis, Roche) which had no bearing on the underlying work. None of the authors have conflicting interests with the data that are presented herein.

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Garweg, R.A., Pfister, I.B., Schild, C. et al. IOP-lowering and drug-sparing effects of trabectome surgery with or without cyclodialysis ab interno. Graefes Arch Clin Exp Ophthalmol 261, 2917–2925 (2023). https://doi.org/10.1007/s00417-023-06063-8

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