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A comparative study of a modified filtering trabeculotomy and conventional trabeculectomy
Juliane Matlach1, Matthias Hipp1, Martin Wagner2
1Department of Ophthalmology, University of Würzburg, Würzburg, Germany.
Clinical Ophthalmology (Auckland, N.Z.)
|March 21, 2015
Summary
Modified filtering trabeculotomy (FTO) without iridectomy showed similar intraocular pressure (IOP) reduction to conventional trabeculectomy. While FTO avoids iridectomy complications, it had a higher rate of some adverse events.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Surgical Techniques
Background:
- Open-angle glaucoma management often involves surgical interventions to lower intraocular pressure (IOP).
- Conventional trabeculectomy is a standard procedure, but potential complications exist.
- Filtering trabeculotomy (FTO) offers an alternative approach to glaucoma surgery.
Purpose of the Study:
- To compare the efficacy and safety of a modified filtering trabeculotomy (FTO) without iridectomy against conventional trabeculectomy (trab).
- To evaluate outcomes including intraocular pressure (IOP), visual acuity, medication use, and complications.
Main Methods:
- A prospective study comparing 30 eyes undergoing modified FTO with 87 eyes undergoing conventional trabeculectomy, matched for age and preoperative IOP.
- The modified FTO involved deep sclerectomy and trabeculotomy, preserving the trabeculo-Descemet membrane, without iridectomy.
- Outcomes measured included complete success (IOP <18 mmHg and ≥30% reduction without medication), IOP, visual acuity, medication needs, complications, and subsequent surgeries over 1 year.
Main Results:
- Both groups achieved significant IOP reduction; median postoperative IOP at 12 months was 11.0 mmHg (modified FTO) vs. 12.0 mmHg (trabeculectomy) (P=0.3).
- Complete success rates at 1 year were comparable: 79.3% for modified FTO and 83.1% for trabeculectomy (P=0.8).
- Complications such as hypotony and choroidal detachment were observed in both groups, with slightly higher rates in the modified FTO group for hypotony (24.1% vs. 20.7%) and choroidal detachment (10.3% vs. 2.3%).
Conclusions:
- Modified FTO without iridectomy demonstrates comparable IOP-lowering efficacy to conventional trabeculectomy over one year.
- Avoiding iridectomy in FTO may reduce cataract formation risk and potentially improve bleb morphology.
- While effective, the modified FTO technique was associated with a higher incidence of certain complications like hypotony and choroidal detachment.
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