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Effectiveness and safety of combined cataract surgery and microhook ab interno trabeculotomy in Japanese eyes with glaucoma: report of an initial case series

  • Clinical Investigation
  • Published:
Japanese Journal of Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To report the early postoperative results and safety profile of ab interno microhook trabeculotomy (μLOT) combined with cataract surgery.

Patients and methods

This retrospective observational case series included 68 consecutive glaucomatous eyes of 23 Japanese men and 25 Japanese women [mean (SD) age, 76.0 ± 8.5 years] who underwent μLOT for intraocular pressure (IOP) and visually relevant cataracts. The LOT site/extent, perioperative complications, and complication treatments were collected from the medical and surgical records. The preoperative and postoperative IOP, numbers of antiglaucoma medications, logarithm of the minimum angle of resolution visual acuity (VA), anterior chamber (AC) flare, and corneal endothelial cell density (CECD) were compared.

Results

After small incisional cataract surgery, the trabecular meshwork was incised in the nasal (6 eyes, 3.6 ± 0.5 clock hours), temporal (6 eyes, 3.8 ± 0.8 clock hours), or both nasal and temporal (56 eyes, 6.5 ± 0.6 clock hours) angles. The mean preoperative IOP (16.4 ± 2.9 mmHg) and number of antiglaucoma medications (2.4 ± 1.2) decreased significantly (P < 0.0001 and P = 0.0039, respectively) to 11.8 ± 4.5 and 2.1 ± 1.0 mmHg at 9.5 months postoperatively. Compared with the preoperative conditions, the final VA improved (P = 0.0002), the AC flare increased by 6.3 pc/ms (P = 0.0157), and the CECD decreased by 6% (P = 0.0005). Hyphema with niveau formation (28 eyes, 41%) and hyphema washout (6 eyes, 9%) were the most common postoperative complication and intervention, respectively. At the final visit, 54 eyes (79%) had achieved successful IOP control of 15 mmHg or less and IOP reduction of 15% or greater.

Conclusion

Combined μLOT and cataract surgery improves IOP and VA during the early postoperative period in patients with glaucoma and cataract.

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References

  1. Chihara E, Nishida A, Kodo M, Yoshimura N, Matsumura M, Yamamoto M, et al. Trabeculotomy ab externo: an alternative treatment in adult patients with primary open-angle glaucoma. Ophthalmic Surg. 1993;24:735–9.

    CAS  PubMed  Google Scholar 

  2. Tanihara H, Negi A, Akimoto M, Terauchi H, Okudaira A, Kozaki J, et al. Surgical effects of trabeculotomy ab externo on adult eyes with primary open angle glaucoma and pseudoexfoliation syndrome. Arch Ophthalmol. 1993;111:1653–61.

    Article  CAS  PubMed  Google Scholar 

  3. Tanito M, Ohira A, Chihara E. Surgical outcome of combined trabeculotomy and cataract surgery. J Glaucoma. 2001;10:302–8.

    Article  CAS  PubMed  Google Scholar 

  4. Tanito M, Ohira A, Chihara E. Factors leading to reduced intraocular pressure after combined trabeculotomy and cataract surgery. J Glaucoma. 2002;11:3–9.

    Article  PubMed  Google Scholar 

  5. Kashiwagi K, Kogure S, Mabuchi F, Chiba T, Yamamoto T, Kuwayama Y, et al. Change in visual acuity and associated risk factors after trabeculectomy with adjunctive mitomycin C. Acta Ophthalmol. 2016;94:e561–70.

    Article  CAS  PubMed  Google Scholar 

  6. Beck AD, Lynch MG. 360 degrees trabeculotomy for primary congenital glaucoma. Arch Ophthalmol. 1995;113:1200–2.

    Article  CAS  PubMed  Google Scholar 

  7. Chin S, Nitta T, Shinmei Y, Aoyagi M, Nitta A, Ohno S, et al. Reduction of intraocular pressure using a modified 360-degree suture trabeculotomy technique in primary and secondary open-angle glaucoma: a pilot study. J Glaucoma. 2012;21:401–7.

    Article  PubMed  Google Scholar 

  8. Dao JB, Sarkisian SR Jr, Freedman SF. Illuminated microcatheter-facilitated 360-degree trabeculotomy for refractory aphakic and juvenile open-angle glaucoma. J Glaucoma. 2014;23:449–54.

    Article  PubMed  Google Scholar 

  9. Grover DS, Godfrey DG, Smith O, Feuer WJ, Montes de Oca I, Fellman RL. Gonioscopy-assisted transluminal trabeculotomy, ab interno trabeculotomy: technique report and preliminary results. Ophthalmology. 2014;121:855–61.

    Article  PubMed  Google Scholar 

  10. Sato T, Hirata A, Mizoguchi T. Outcomes of 360 degrees suture trabeculotomy with deep sclerectomy combined with cataract surgery for primary open angle glaucoma and coexisting cataract. Clin Ophthalmol. 2014;8:1301–10.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sato T, Hirata A, Mizoguchi T. Prospective, noncomparative, nonrandomized case study of short-term outcomes of 360 degrees suture trabeculotomy ab interno in patients with open-angle glaucoma. Clin Ophthalmol. 2015;9:63–8.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Tanito M, Sano I, Ikeda Y, Fujihara E. Microhook ab interno trabeculotomy, a novel minimally invasive glaucoma surgery, in eyes with open-angle glaucoma with scleral thinning. Acta Ophthalmol. 2016;94:e371–2.

    Article  PubMed  Google Scholar 

  13. Tanito M, Sano I, Ikeda Y, Fujihara E. Short-term results of micro-hook ab interno trabeculotomy, a novel minimally invasive glaucoma surgery in Japanese eyes: initial case series. Acta Ophthalmologica. 2017;. doi:10.1111/aos.13288.

    PubMed  Google Scholar 

  14. Honjo M, Tanihara H, Inatani M, Honda Y, Ogino N, Ueno S, et al. Phacoemulsification, intraocular lens implantation, and trabeculotomy to treat pseudoexfoliation syndrome. J Cataract Refract Surg. 1998;24:781–6.

    Article  CAS  PubMed  Google Scholar 

  15. Tanihara H, Negi A, Akimoto M, Nagata M. Long-term results of non-filtering surgery for the treatment of primary angle-closure glaucoma. Graefes Arch Clin Exp Ophthalmol. 1995;233:563–7.

    Article  CAS  PubMed  Google Scholar 

  16. Chen PP, Lin SC, Junk AK, Radhakrishnan S, Singh K, Chen TC. The effect of phacoemulsification on intraocular pressure in glaucoma patients: a report by the American Academy of Ophthalmology. Ophthalmology. 2015;122:1294–307.

    Article  PubMed  Google Scholar 

  17. Kobayashi H, Kobayashi K. Randomized comparison of the intraocular pressure-lowering effect of phacoviscocanalostomy and phacotrabeculectomy. Ophthalmology. 2007;114:909–14.

    Article  PubMed  Google Scholar 

  18. Rosenquist R, Epstein D, Melamed S, Johnson M, Grant WM. Outflow resistance of enucleated human eyes at two different perfusion pressures and different extents of trabeculotomy. Curr Eye Res. 1989;8:1233–40.

    Article  CAS  PubMed  Google Scholar 

  19. Chihara E, Umemoto M, Tanito M. Preservation of corneal endothelium after pars plana tube insertion of the Ahmed glaucoma valve. Jpn J Ophthalmol. 2012;56:119–27.

    Article  PubMed  Google Scholar 

  20. Siriwardena D, Kotecha A, Minassian D, Dart JK, Khaw PT. Anterior chamber flare after trabeculectomy and after phacoemulsification. Br J Ophthalmol. 2000;84:1056–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Hayashi K, Manabe S, Yoshimura K, Kondo H. Corneal endothelial damage after cataract surgery in eyes with pseudoexfoliation syndrome. J Cataract Refract Surg. 2013;39:881–7.

    Article  PubMed  Google Scholar 

  22. Schumacher S, Nguyen NX, Kuchle M, Naumann GO. Quantification of aqueous flare after phacoemulsification with intraocular lens implantation in eyes with pseudoexfoliation syndrome. Arch Ophthalmol. 1999;117:733–5.

    Article  CAS  PubMed  Google Scholar 

  23. Ahmed IIK. MIGS and the FDA: what’s in a name? Ophthalmology. 2015;122:1737–9.

    Article  PubMed  Google Scholar 

  24. Kahook MY, Seibold LK, SooHoo JR, Mansouri K, Sharaawy T. A nuanced approach to the surgical management of glaucoma. Middle East Afr J Ophthalmol. 2015;22:1.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Minckler DS, Baerveldt G, Alfaro MR, Francis BA. Clinical results with the Trabectome for treatment of open-angle glaucoma. Ophthalmology. 2005;112:962–7.

    Article  PubMed  Google Scholar 

  26. Malvankar-Mehta MS, Chen YN, Iordanous Y, Wang WW, Costella J, Hutnik CM. iStent as a solo procedure for glaucoma patients: a systematic review and meta-analysis. PLoS ONE. 2015;10:e0128146.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Khaimi MA. Canaloplasty: a minimally invasive and maximally effective glaucoma treatment. J Ophthalmol. 2015;2015:485065.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Matlach J, Dhillon C, Hain J, Schlunck G, Grehn F, Klink T. Trabeculectomy versus canaloplasty (TVC study) in the treatment of patients with open-angle glaucoma: a prospective randomized clinical trial. Acta Ophthalmol. 2015;93:753–61.

    Article  PubMed  Google Scholar 

  29. Seibold LK, Soohoo JR, Ammar DA, Kahook MY. Preclinical investigation of ab interno trabeculectomy using a novel dual-blade device. Am J Ophthalmol. 2013;155:524–9.

    Article  PubMed  Google Scholar 

  30. SooHoo JR, Seibold LK, Kahook MY. Ab interno trabeculectomy in the adult patient. Middle East Afr J Ophthalmol. 2015;22:25–9.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Division of Ophthalmology, Matsue Red Cross Hospital, 200 Horo-machi, Matsue, Shimane, 690-8506, Japan

    Masaki Tanito, Yoshifumi Ikeda & Etsuko Fujihara

Authors
  1. Masaki Tanito
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  2. Yoshifumi Ikeda
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  3. Etsuko Fujihara
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Corresponding author

Correspondence to Masaki Tanito.

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Conflicts of interest

M. Tanito, Grants (Inami), Lecture fees (Aeon Astron, Alcon, HOYA, JFC, Kowa, MSD, NIDEK, Novartis, Otsuka, Pfizer, Santen, Senju, Zeiss), Supply of microhooks (Inami); Y. Ikeda, Grants (Inami), Lecture fees (Santen), Supply of microhooks (Inami); E. Fujihara, Grants (Inami), Lecture fees (Kowa, Novartis), Supply of microhooks (Inami).

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Video 1. Microhook ab interno trabeculotomy combined with cataract surgery in the left eye. (MP4 47006 kb)

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Tanito, M., Ikeda, Y. & Fujihara, E. Effectiveness and safety of combined cataract surgery and microhook ab interno trabeculotomy in Japanese eyes with glaucoma: report of an initial case series. Jpn J Ophthalmol 61, 457–464 (2017). https://doi.org/10.1007/s10384-017-0531-z

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  • DOI: https://doi.org/10.1007/s10384-017-0531-z

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