This article is more than 5 years old. Information may no longer be current.
Trabectome shows higher success rate with low IOP
Click Here to Manage Email Alerts
Surgery with the Trabectome significantly reduces IOP in patients with glaucoma and has the highest rate of success when baseline IOP is lower, the cornea is thinner and cataract surgery is performed at the same time, according to a study.
Seventy-eight glaucoma patients (86 eyes) who underwent Trabectome (NeoMedix) surgery and were followed up for more than 1 year were included. The possible influencing factors were investigated, including age, sex, glaucoma index (GI), preoperative IOP, number of medications, visual field, central corneal thickness, type of glaucoma and combination with cataract surgery. Success was defined as IOP less than 21 mm Hg, IOP reduction by at least 20% at 3 months and no secondary glaucoma surgery.
At 1 year, the mean postoperative IOP was 12.5 mm Hg, significantly lower than previous reports because the patients remained on glaucoma medications, as recommended by the Japan Trabectome Study Group.
Preoperative IOP was the main factor that influenced Trabectome results. Patients with IOP lower than 21 mm Hg showed significantly better results.
“Trabectome could be a useful treatment for low-IOP glaucoma,” the authors wrote.
Combination with cataract surgery was also correlated with significantly better results, likely due to the opening of the anterior chamber angle and better outflow, they said.
Central corneal thickness, which is known to be closely related with IOP, was another significant factor. Specifically, thinner corneas had better results, according to the study. Eyes that had previously undergone selective laser trabeculoplasty had a lower success rate.
However, “few patients had undergone SLT treatment, and so the statistical significance of the results might be low,” the authors pointed out.
None of the other factors had a significant impact on the outcomes of Trabectome surgery. – by Michela Cimberle
Disclosure: The authors reported no conflict of interest.
Perspective
Back to Top
Scott Anthony, OD, FAAO
The quest to deliver precision glaucoma care is making headway in both medical and surgical treatments. Ideal medical lowering of intraocular pressure now entails no preservatives and once-daily dosing. Ideal surgical lowering of IOP now looks to spare conjunctival involvement using minimally invasive surgical techniques and devices (MIGS). For today’s glaucoma treatments, less is more.
This study highlights the effectiveness of Trabectome to lower IOP by selectively removing the trabecular meshwork and inner wall of Schlemm’s canal. This targeted surgical approach has been around for over 10 years and has been well studied. Other surgical devices for removing the trabecular meshwork/Schlemm’s complex have been developed recently that will compete to be the preferred choice for this treatment strategy.
The surgical menu for glaucoma patients is expanding, creating varied surgical approaches among glaucoma specialists. Understanding the expected outcomes for many of the MIGS techniques will help guide your medical treatment plans for long-term care of your glaucoma patients.
Click Here to Manage Email Alerts