Gábor Holló and Andreas Katsanos
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The recently developed technique of ab-interno trabeculotomy with the
Trabectome™ (Neomedix Inc., Tustin, CA, US) has been approved for the
treatment of open angle glaucoma. A 12 months, prospective, non-randomized
study evaluated the outcomes of Trabectome™ surgery alone and in
combination with cataract surgery and intraocular lens implantation in XFG
and POAG eyes [90]. For the “Trabectome™ surgery only” analysis the
preoperative IOP was 29.0 mmHg and 25.5 mmHg for the XFG (n=67) and
the POAG group (n=450; P<0.01), and the IOP decreased by 12.3 ± 8.0
mmHg and 7.5 ± 7.4 mmHg in the XFG and POAG group, respectively
(P<0.01). The cumulative probability of success for the XFG and POAG
groups was 79.1% and 62.9%, respectively (P=0.004). In the “combined
Trabectome™ plus cataract surgery” analysis the mean preoperative IOP was
21.7 mmHg and 19.9 mmHg for the XFG (n=45) and the POAG (n=263)
group (P=0.06), and the IOP decreased by 7.2 mmHg and 4.1 mmHg in the
XFG and POAG groups, respectively (P<0.01). The cumulative probability of
success for the XFG and POAG group was 86.7% and 91.0%, respectively
(P=0.73). The results suggest that ab-interno trabeculotomy offers superior
IOP control in XFG compared to POAG.
Trabecular aspiration is a technique specifically developed for the
treatment of XFG based on the notion that surgical removal of the exfoliation
material and pigment granules deposited on the intra-trabecular spaces should
enhance aqueous humor outflow. [ 91 ] In a prospective trial with 22 eyes of 19
patients with uncontrolled XFG the mean preoperative IOP on medication
(31.3 mmHg) was significantly lowered to 16.8 mmHg 18 months after
trabecular aspiration [91]. Following the procedure, 45% of the patients
required no IOP lowering medication. In the same study, the authors evaluated
the efficacy of trabecular aspiration combined with phacoemulsification or
extracapsular cataract surgery in 42 eyes of 36 patients with uncontrolled XFG
and cataract. For these eyes the mean preoperative IOP on medication (32.4
mmHg) significantly decreased to 18.7 mmHg 2 years after the combined
procedure [91]. In this subgroup, 54% of the participants did not need
medication at the end of the 2-year follow-up period. In another prospective,
controlled study the same authors compared the efficacy of
phacoemulsification, combined phacoemulsification and trabecular aspiration,
and combined phacoemulsification and trabeculectomy on 74 non-operated
eyes with XFG and cataract [92]. Failure was defined as the necessity for
additional surgical or laser interventions (except for laser suture lysis), or the
need for more than one medication to reach an individualized target pressure.
After a 2-year follow-up period the proportions of successfully treated patients