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Phaco with Trabectome shows higher IOP reduction in more advanced stages of glaucoma
Combination of phacoemulsification and Trabectome surgery in a large retrospective series showed a higher IOP reduction in patients with more advanced stages of glaucoma.
According to the authors of the study, this demonstrates that “the trabecular meshwork is the primary impediment to outflow, and its ablation benefits those eyes relatively more than in mild glaucoma.”
Ab interno trabeculectomy creates a disruption in the trabecular meshwork to let the aqueous flow directly out of the anterior chamber. In this study, Trabectome (NeoMedix) was combined with phacoemulsification in a series of 498 cases that had glaucoma and cataract. Based on a glaucoma severity index that included baseline IOP, number of medications and visual field status, patients were stratified into four groups.
IOP reduction and the success rate at 12 months were the primary outcome measures, with the latter defined as IOP of 21 mm Hg or less, IOP reduction of more than 20% at two consecutive visits after 3 months and no need for another surgery. The relationship between glaucoma index group, IOP and medications at 1 year was measured with linear regression analysis.
A decrease in IOP was seen across all groups at 1 year after surgery, but significant differences were found between the groups. Group 4, which included patients with the most advanced glaucoma, had an average reduction of 10 mm Hg as compared with approximately 4 mm Hg in the other three groups. Medications were reduced in all groups, but the largest reduction was reported in groups 3 and 4 at 1 year. – by Michela Cimberle
Disclosure: Roy reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Roy P, et al. BMC Ophthalmol. 2017;doi:10.1186/s12886-017-0421-7.