Long-term clinical results of trabectome surgery in patients with open-angle glaucoma
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GLAUCOMA
Long-term clinical results of trabectome surgery in patients with open-angle glaucoma Yusuke Kono 1 & Masayuki Kasahara 2 & Kazunori Hirasawa 2 & Tatsuhiko Tsujisawa 1 & Shunsuke Kanayama 1 & Kazuhiro Matsumura 2,3 & Tetsuya Morita 2,4 & Nobuyuki Shoji 1,2 Received: 3 June 2020 / Revised: 9 August 2020 / Accepted: 16 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To evaluate the 72-month clinical results of trabectome surgery (TOM) in patients with primary open-angle glaucoma (POAG), secondary OAG and childhood glaucoma. Method A total of 305 eyes from 249 glaucoma patients were analyzed in the current retrospective single-center study. KaplanMeier analysis was performed using three criteria: criterion A (postoperative intraocular pressure [IOP] ≤ 21 mmHg and ≥ 20% reduction from baseline IOP); criterion B (postoperative IOP ≤ 18 mmHg and ≥ 20% reduction from baseline IOP); and criterion C (postoperative IOP ≤ 16 mmHg and ≥ 20% reduction from baseline IOP). The changes in IOP, medication score, success probability, results of the multivariate analysis for success and failure risk factors, and complications were analyzed. Results The baseline IOP in all glaucoma patients decreased from 29.2 ± 9.8 mmHg with a 5.3 ± 1.7 medication score to 16.4 ± 5.8 mmHg (− 43.8%) with a 4.2 ± 1.5 medication score at 72 months (p < 0.01). The success probabilities in all cases for 72 months based on criterion A, B, and C were 44%, 35%, and 17%, respectively. For criterion A, no significant differences were found in the success probability according to the glaucoma subtype for 72 months. The combined surgical procedure significantly decreased the failure risk (hazard ratio [HR]: 0.59). On the other hand, the presence of POAG (HR: 1.6) and a history of past selective laser trabeculoplasty (HR: 2.2) significantly increased failure risk. One patient (0.3%) demonstrated endophthalmitis after TOM but recovered through appropriate treatment. Conclusion At the 72-month time point, approximately half of the glaucoma patients maintained an IOP ≤ 21 mmHg with ≥ 20% IOP reduction. TOM is a safe surgery but may not yield sufficient IOP reduction in patients who have received SLT or have POAG.
Key messages We investigated the 72-month clinical results of trabectome (TOM) surgery in 305 eyes of 249 patients involving primary open-angle glaucoma (POAG), secondary OAG (SOAG) and childhood glaucoma (CG). The current study suggests that approximately half of glaucoma patients maintained IOP≤21 mmHg and ≥20% IOP reduction. TOM surgery might not yield sufficient IOP reduction in patients who have received selective laser trabeculoplasty or have POAG.
* Nobuyuki Shoji [email protected]
Shunsuke Kanayama [email protected]
Yusuke Kono [email protected]
Kazuhiro Matsumura [email protected]
Masayuki Kasahara [email protected]
Tetsuya Morita [email protected]
Kazunori Hirasawa [email protected] Tatsuhiko Tsujisawa [email protected]
Extended au
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