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New procedure reduces IOP in patients with open-angle and juvenile glaucoma
J Glaucoma. 2010;doi:10.1097/IJG.0b013e3181dddf31.
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Sclerothalamotomy ab interno, a new trabecular surgery, may be effective in treating open-angle glaucoma, a long-term study showed.
"Sclerothalamotomy ab interno is a minimally invasive, safe and efficient surgical technique for lowering the IOP in open-angle and juvenile glaucoma," the study authors said.
The procedure involved the insertion of a high-frequency diathermic probe through a 1.2-mm temporal clear corneal incision and the injection of viscosurgical material through a second corneal incision 120° apart from the temporal incision. The probe penetrated up to 1 mm nasally into the sclera and through the trabecular meshwork and Schlemm's canal, forming a deep sclerotomy 0.3 mm high and 0.6 mm wide.
The study included 53 eyes of 53 patients with open-angle glaucoma and five eyes of five patients with juvenile glaucoma. Mean age was 72.3 years for the open-angle glaucoma patients and 9 years for the juvenile glaucoma patients.
The primary inclusion criterion was inadequate response to medical management of IOP.
Mean baseline IOP was 25.6 mm Hg in the open-angle glaucoma group and 39.6 mm Hg in the juvenile glaucoma group. All patients underwent follow-up evaluation for at least 72 months after surgery.
At 72 months, mean IOP was 14.7 mm Hg in the open-angle glaucoma group and 13.2 mm Hg in the juvenile glaucoma group.
IOP reduction was statistically significant for both groups at all follow-up points (P < .001).
Also at 72 months, 52.8% of open-angle glaucoma patients and 80% of juvenile glaucoma patients had IOP lower than 15 mm Hg. Complete success, defined as IOP lower than 21 mm Hg without medication at 72 months, was attained in 42 open-angle glaucoma patients and four juvenile glaucoma patients.
Eleven eyes in the open-angle glaucoma group and one eye in the juvenile glaucoma group required IOP-reducing medications at 72 months, the authors said.
Further study with a larger patient group is needed to sufficiently gauge the safety and efficacy of the procedure for juvenile glaucoma, they said.
The authors present the follow-up of a single case series. The 5-year success rates and magnitude of IOP lowering reported in this paper are notable. Further study is needed to more fully assess the appropriate role of sclerothalamotomy. However, the data presented from this cohort of patients may be promising.
– Douglas J. Rhee, MD
OSN Glaucoma Board
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