Combined Ab-Interno Trabeculectomy and Trabecular Aspiration as a Simultaneous versus Sequential Addition to Phacoemulsification in Exfoliative Eyes
David Kiessling, Alexandra Lappas, Thomas S. Dietlein, Gernot F. Roessler, Randolf A. WidderAbstract
Purpose:
To determine differing outcomes among pseudophakic patients with exfoliation glaucoma who underwent combined trabectome surgery and trabecular aspiration and phakic patients treated by a triple procedure with additional phacoemulsification.
Methods:
This retrospective study involved 75 eyes of 75 participants, of which 25 eyes received combined ab-interno trabeculectomy and trabecular aspiration (Trabectome + TA group), and 50 eyes underwent a triple procedure with additional phacoemulsification (triple group). The groups were matched at a 1:2 ratio, based on the following criteria: preoperative intraocular pressure (IOP), maximum known preoperative IOP, preoperative medication score, cup/disc ratio, follow-up time, and age. Successful surgery was defined by three scores: IOP at longest follow-up <21 mmHg (Score A) or <18 mmHg (Score B), without re-surgery and an IOP reduction >20% or IOP ≤15 mmHg without re-surgery and an IOP reduction ≥40% (Score C).
Results:
The preoperative IOP was 23.7 ± 5 mmHg, respectively, and decreased to 15.2 ± 4 mmHg in the triple group, which is significantly lower than postoperative IOP in the Trabectome + TA group, being 18.6 ± 8 mmHg during an average follow-up period of 33.4 ± 26 months (
Conclusions:
Cataract extraction, as a part of a triple procedure, seems to contribute to more effective IOP-lowering than trabectome surgery and trabecular aspiration alone in patients who underwent standalone phacoemulsification previously.