Trabectome surgery for primary and secondary open angle glaucomas.

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Minimally Invasive Procedures

Background:

• Open-angle glaucoma (OAG) is characterized by elevated intraocular pressure (IOP) due to impaired aqueous humor outflow through the trabecular meshwork.
• The Trabectome device offers a minimally invasive surgical option for OAG by targeting the juxtacanalicular meshwork.

Purpose of the Study:

• To compare the effectiveness and complication profile of Trabectome surgery across different open-angle glaucoma subgroups.
• To evaluate IOP reduction and medication usage post-surgery.

Main Methods:

• A prospective observational study included 557 eyes from 487 patients undergoing Trabectome surgery, alone or combined with cataract surgery.
• Intraoperative and postoperative complications were systematically documented.
• Statistical analysis focused on primary open-angle glaucoma and pseudoexfoliation glaucoma subgroups.

Main Results:

• In primary open-angle glaucoma (261 eyes), mean IOP decreased from 24 mmHg to 18 mmHg, and medications reduced from 2.1 to 1.2.
• In pseudoexfoliation glaucoma (173 eyes), mean IOP decreased from 25 mmHg to 18 mmHg, and medications reduced from 2.0 to 1.1.
• Combined surgery (Trabectome + cataract surgery) showed superiority over Trabectome alone in phakic/pseudophakic eyes; no serious complications were reported.

Conclusions:

• Minimally invasive glaucoma surgery with the Trabectome is safe and effective for open-angle glaucoma.
• Subgroup analysis aids in patient selection for Trabectome surgery.
• The procedure's lack of ocular surface alterations makes it a valuable glaucoma treatment option.