Trabeculotomy opening size and IOP reduction after Trabectome® surgery

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Anatomic Factors in Ocular Surgery

Background:

• Trabeculotomy with the Trabectome® is a surgical option for lowering intraocular pressure (IOP).
• Some patients experience insufficient IOP reduction despite a visible opening of Schlemm's canal after trabeculotomy.
• The relationship between surgical parameters and IOP reduction requires further investigation.

Purpose of the Study:

• To investigate the correlation between trabeculotomy opening size and IOP reduction after Trabectome surgery.
• To assess the influence of anterior chamber depth (ACD) and other parameters on IOP reduction.
• To explore factors affecting the success of trabeculotomy in glaucoma management.

Main Methods:

• Retrospective observational case series of 93 eyes undergoing Trabectome surgery.
• Anterior segment swept source OCT used to measure trabeculotomy opening size and ACD.
• IOP measured pre-operatively and at follow-up; analyzed using multiple linear regression.

Main Results:

• Trabeculotomy opening size did not correlate with IOP reduction (p > 0.05).
• Anterior chamber depth (ACD) showed a trend towards better IOP reduction with deeper AC, but was not statistically significant (p > 0.05).
• Eyes with larger trabeculotomy openings had significantly deeper ACDs (p = 0.031).

Conclusions:

• Trabeculotomy opening size is not a predictor of IOP reduction in Trabectome surgery.
• The intrascleral aqueous outflow pathway's role in glaucomatous IOP elevation remains poorly understood.
• Deeper anterior chamber depth may be associated with larger trabeculotomy openings, but its direct impact on IOP reduction needs further study.