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The effect of additional trabecular aspiration to phacoemulsification and trabectome as a triple procedure in pseudoexfoliation glaucoma: a case-matched study

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Abstract

Background

Trabectome surgery combined with phacoemulsification is effective in lowering (intraocular pressure) IOP in pseudoexfoliation glaucoma. Trabectome surgery usually aims to remove two to four clock hours of the trabecular meshwork. When adding trabecular aspiration, the remaining meshwork can be treated as well, and therefore 360 degrees of the meshwork can be reached. This study was conducted to investigate the additional benefits and risks of adding trabecular aspiration to the combination of phacoemulsification and trabectome as a triple procedure.

Methods

Two groups of patients from two centres were compared. The first group underwent phacoemulsification and trabectome (Freiburg), and the second group underwent additional trabecular aspiration (Düsseldorf). Using a case-matched retrospective study design, 50 patients were included into each group. The clinical endpoint was the intraocular pressure at follow up.

Results

The mean follow up was 22 months. Mean intraocular pressure decreased in all 100 patients from 25.0 (SD 4.3) to 14.9 mmHg (SD 4.0). Comparing the two groups, the IOP reduction was from 25.0 (SD 5.0) to 14.1 (SD 4.4) mmHg in the triple procedure group compared to a reduction from 25.0 (3.6) to 15.7 (SD 3.4) mmHg in the phaco/trabectome group. The difference was statistically significant (p = 0.03). The number of medication after surgery was reduced from 2.2 (SD 0.9) to 1.7 (SD 0.9) while in the phaco/trabectome group the medication score was reduced from 2.2 (SD 1.0) to 1.1 (SD 0.1) (p < 0.001).

Conclusions

This study shows that the combination of trabectome surgery and phacoemulsification leads to a clinically significant reduction of IOP over several years in patients with pseudoexfoliation glaucoma. The addition of trabecular aspiration as a triple procedure results in further lowering of IOP without causing more side effects. This finding might be biased by the higher medication score in the triple procedure group.

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References

  1. Minckler D, Mosaed S, Dustin L et al (2008) Trabectome (trabeculectomy-internal approach): additional experience and extended follow-up. Trans Am Ophthalmol Soc 106:149–159 (discussion 159–60)

    PubMed  PubMed Central  Google Scholar 

  2. Ting JLM, Damji KF, Stiles MC, Trabectome Study Group (2012) Ab interno trabeculectomy: outcomes in exfoliation versus primary open-angle glaucoma. J Cataract Refract Surg 38:315–323. doi:10.1016/j.jcrs.2011.08.043

    Article  PubMed  Google Scholar 

  3. Jacobi PC, Dietlein TS, Krieglstein GK (1999) Comparative study of trabecular aspiration vs trabeculectomy in glaucoma triple procedure to treat pseudoexfoliation glaucoma. Arch Ophthalmol 117:1311–1318

    Article  CAS  Google Scholar 

  4. Dinslage S, Rosentreter A, Schild AM et al (2012) Combined phacoemulsification with trabecular aspiration with differing outcomes in pseudoexfoliative glaucoma—a retrospective study. Klin Monatsblätter für Augenheilkd 229:641–644. doi:10.1055/s-0031-1282014

    Article  CAS  Google Scholar 

  5. Widder RA, Dietlein TS (2016) Surgical options before and after trabectome surgery: impact of previous surgeries, possibilities of revision surgery and complication management. Ophthalmologe. doi:10.1007/s00347-016-0360-3

    Article  PubMed  Google Scholar 

  6. Klamann MKJ, Gonnermann J, Maier A-KB et al (2013) Combined clear cornea phacoemulsification in the treatment of pseudoexfoliative glaucoma associated with cataract: significance of trabecular aspiration and ab interno trabeculectomy. Graefes Arch Clin Exp Ophthalmol 251:2195–2199. doi:10.1007/s00417-013-2408-2

    Article  PubMed  Google Scholar 

  7. Widder RA, Dinslage S, Rosentreter A et al (2014) A new surgical triple procedure in pseudoexfoliation glaucoma using cataract surgery, trabectome, and trabecular aspiration. Graefes Arch Clin Exp Ophthalmol 252:1971–1975. doi:10.1007/s00417-014-2795-z

    Article  PubMed  Google Scholar 

  8. Ritch R, Schlötzer-Schrehardt U (2001) Exfoliation syndrome. Surv Ophthalmol 45:265–315

    Article  CAS  Google Scholar 

  9. Dietlein TS, Widder RA, Jordan JF et al (2013) Combined cataract and glaucoma surgery: current options. Ophthalmologe 110:310–315. doi:10.1007/s00347-012-2765-y

    Article  CAS  PubMed  Google Scholar 

  10. Lochhead J (2003) Long term effect on intraocular pressure of phacotrabeculectomy compared to trabeculectomy. Br J Ophthalmol 87:850–852. doi:10.1136/bjo.87.7.850

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Friedman DS, Jampel HD, Lubomski LH et al (2002) Surgical strategies for coexisting glaucoma and cataract: an evidence-based update. Ophthalmology 109:1902–1913

    Article  Google Scholar 

  12. Jacobi PC, Krieglstein GK (1995) Trabecular aspiration. A new mode to treat pseudoexfoliation glaucoma. Invest Ophthalmol Vis Sci 36:2270–2276

    CAS  PubMed  Google Scholar 

  13. Jacobi PC, Krieglstein GK (1994) Trabecular aspiration: a new surgical approach to improve trabecular facility in pseudoexfoliation glaucoma. Int Ophthalmol 18:153–157. doi:10.1007/BF00915964

    Article  CAS  PubMed  Google Scholar 

  14. Georgopoulos GT, Chalkiadakis J, Livir-Rallatos G et al (2000) Combined clear cornea phacoemulsification and trabecular aspiration in the treatment of pseudoexfoliative glaucoma associated with cataract. Graefes Arch Clin Exp Ophthalmol 238:816–821

    Article  CAS  Google Scholar 

  15. Rosentreter A, Dinslage S, Krieglstein GK, Dietlein TS (2010) Intra-individual comparison after combined phaco-trabecular aspiration in pairs of pseudoexfoliative eyes. Graefes Arch Clin Exp Ophthalmol 248:79–83. doi:10.1007/s00417-009-1174-7

    Article  PubMed  Google Scholar 

  16. Minckler DS, Baerveldt G, Alfaro MR, Francis BA (2005) Clinical results with the Trabectome for treatment of open-angle glaucoma. Ophthalmology 112:962–967. doi:10.1016/j.ophtha.2004.12.043

    Article  PubMed  Google Scholar 

  17. Kaplowitz K, Bussel II, Honkanen R et al (2016) Review and meta-analysis of ab-interno trabeculectomy outcomes. Br J Ophthalmol. doi:10.1136/bjophthalmol-2015-307131

    Article  PubMed  Google Scholar 

  18. Jordan JF, Wecker T, van Oterendorp C et al (2013) Trabectome surgery for primary and secondary open angle glaucomas. Graefes Arch Clin Exp Ophthalmol 251:2753–2760. doi:10.1007/s00417-013-2500-7

    Article  PubMed  PubMed Central  Google Scholar 

  19. Francis BA, Minckler D, Dustin L et al (2008) Combined cataract extraction and trabeculotomy by the internal approach for coexisting cataract and open-angle glaucoma: initial results. J Cartaract Refract Surg 34:1096–1103. doi:10.1016/j.jcrs.2008.03.032

    Article  Google Scholar 

  20. Bussel II, Kaplowitz K, Schuman JS et al (2014) Outcomes of ab interno trabeculectomy with the trabectome after failed trabeculectomy. Br J Ophthalmol. doi:10.1136/bjophthalmol-2013-304717

    Article  PubMed  PubMed Central  Google Scholar 

  21. Mosaed S, Chak G, Haider A et al (2015) Results of trabectome surgery following failed glaucoma tube shunt implantation: cohort study. Medicine (Baltimore) 94:e1045. doi:10.1097/MD.0000000000001045

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology, St. Martinus-Krankenhaus Düsseldorf, Gladbacher Str. 26, 40219, Düsseldorf, Germany

    R. A. Widder, P. Kühnrich & G. F. Roessler

  2. Eye Center, Medical Center, University of Freiburg, Kilianstrasse 5, 79106, Freiburg, Germany

    J. F. Jordan, J. Luebke & A. Anton

  3. Eye Center Vobig and Jordan, Hans-Thoma-Str. 24, 60596, Frankfurt, Germany

    J. F. Jordan

Authors
  1. R. A. Widder
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  2. J. F. Jordan
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  3. P. Kühnrich
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  4. J. Luebke
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  5. G. F. Roessler
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  6. A. Anton
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Correspondence to R. A. Widder.

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The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study (retrospective), formal consent is not required.

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Widder, R.A., Jordan, J.F., Kühnrich, P. et al. The effect of additional trabecular aspiration to phacoemulsification and trabectome as a triple procedure in pseudoexfoliation glaucoma: a case-matched study. Int Ophthalmol 38, 2341–2347 (2018). https://doi.org/10.1007/s10792-017-0732-y

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  • DOI: https://doi.org/10.1007/s10792-017-0732-y

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