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Speaker considers surgical options for pseudoexfoliation glaucoma
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FORT LAUDERDALE, Fla. — Pseudoexfoliation glaucoma is more aggressive than primary open-angle glaucoma and often requires surgical intervention, but few studies have been done to investigate surgical success specifically for pseudoexfoliation, according to a speaker.
Among surgical options are filtering surgery, tube shunt placement and non-penetrating surgery, Helen L. Kornmann, MD, PhD, said at the American Glaucoma Society meeting.
Helen L. Kornmann
“Trabeculectomy remains the most commonly performed incisional surgery for the management of glaucoma; however, there are very few studies comparing outcomes in pseudoexfoliation glaucoma vs. primary open-angle glaucoma,” she said. Depending on the study, better outcomes have been seen in both patient populations, those with pseudoexfoliation glaucoma and those with primary open-angle glaucoma.
Pseudoexfoliation is associated with an increase in cataract formation. Even though one study has shown greater IOP reduction up to 10 years postoperatively in glaucomatous eyes that undergo combined phacoemulsification and trabeculectomy than in eyes that undergo cataract surgery alone, no studies compare failure rates of the two treatments specifically for pseudoexfoliation glaucoma, Kornmann said.
“With regard to aqueous shunt implants, there are no studies directly looking at this in pseudoexfoliation glaucoma; however, the [Tube Versus Trabeculectomy Study] does provide some insights into patients who have had previous ocular surgery,” she said, with the results supporting the use of aqueous shunts beyond only refractory glaucoma, with the caveat that a recent study associated pseudoexfoliation glaucoma with a higher risk of tube exposure.
Trabecular aspiration and ab interno trabeculectomy (Trabectome, NeoMedix) are two angle-based procedures that specifically address the accumulation of pseudoexfoliative material in the trabecular meshwork. They are non-penetrating, there is no transscleral drainage of aqueous into the subconjunctival space, and the conjunctiva is preserved for possible future filtration or shunt devices.
Postoperatively, patients with pseudoexfoliation are prone to increased inflammation, abnormalities of the blood-aqueous barrier that can result in flare/fibrin, posterior synechiae and macular edema, as well as IOP spikes that should be monitored closely, Kornmann said. – by Patricia Nale, ELS
Disclosure: Kornmann reports no relevant financial disclosures.