[Long-term results of combined surgery for open-angle glaucoma]

Area of Science:

• Ophthalmology
• Surgical Innovation

Background:

• Open-angle glaucoma (POAG) is a leading cause of irreversible blindness.
• Current treatments aim to reduce intraocular pressure (IOP) to prevent optic nerve damage.
• Surgical interventions are considered when medical management is insufficient.

Purpose of the Study:

• To compare the efficacy of a minimally invasive technique (type 1) versus a basic technique (type 2) for subscleral removal of the external wall of Schlemm's canal.
• To evaluate the subsequent hypotensive effect of laser trabeculopuncture in patients with POAG.

Main Methods:

• A comparative study involving 60 patients (64 eyes) in the minimally invasive group and 105 patients (105 eyes) in the basic technique group.
• Both groups underwent subscleral removal of the external wall of Schlemm's canal followed by laser trabeculopuncture.
• Intraocular pressure (IOP) was measured pre- and post-operatively and at 12 months.

Main Results:

• Both surgical techniques resulted in a significant decrease in IOP post-sinusotomy (approx. 25%) and further reduction after laser trabeculopuncture (15.6±0.4 mmHg in the main group, 17.4±0.3 mmHg in the control group).
• The hypotensive effect was sustained at 12 months in a high percentage of patients (81.2% minimally invasive, 90.5% basic technique).
• No patients required additional hypotensive therapy post-surgery.

Conclusions:

• The minimally invasive subscleral removal of the external wall of Schlemm's canal (microfistulizing procedure) followed by laser trabeculopuncture demonstrates a hypotensive effect comparable to the basic technique in POAG patients.
• This suggests that the minimally invasive approach is a viable and effective alternative for managing open-angle glaucoma.