Two-year outcomes of modified external suture trabeculotomy for Chinese open-angle glaucoma patients

This study aimed to evaluate the 2-year outcomes of modified external suture trabeculotomy in the treatment of open-angle glaucoma (OAG) among Chinese patients.

A retrospective study was designed, involving 138 OAG patients (138 eyes) treated with modified external suture trabeculotomy at the First Affiliated Hospital of Nanjing Medical University from January 2020 to June 2023. The patients were followed up at 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years. Surgical success was defined as intraocular pressure (IOP) ≤ 21 mmHg (1 mmHg = 0.133 kPa) under glaucoma medication (conditional success) and without any glaucoma medication (complete success). The main outcomes were measured according to IOP, number of medication regimens, surgical success rate, and complications.

A total of 138 OAG patients (138 eyes) were included, with a mean age of 58.57 ± 13.66 years (range, 25-86 years). The mean postoperative IOP decreased from preoperative 24.59 ± 9.82 to postoperative 15.50 ± 6.49, 15.70 ± 5.76, 14.36 ± 3.59, 14.49 ± 3.96, 14.71 ± 4.31, and 14.31 ± 3.16 mm Hg at 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years, respectively. The mean numbers of medication regimens were 2 (0 ~ 4), 0 (0 ~ 3), 0 (0 ~ 3), 0 (0 ~ 3), 0 (0 ~ 2), 0 (0 ~ 3), 0 (0 ~ 3) at the seven time points, respectively. The mean postoperative IOP and the number of medication regimens at each time point were significantly lower than those before the operation (all p < 0.01). The 2-year total success rate was 93.3%, and the complete success rate was 82.5%. Hyphema (79.0%) and transient rise of IOP (16.7%) were the most common complications early after surgery. Descemet's membrane detachment occurred in nine eyes (6.5%), and ciliary body detachment in four eyes (2.9%).

Simple and cost-effective, the modified external suture trabeculotomy provides favorable 2-year outcomes in treating medically uncontrolled OAG, as shown by short surgical duration, effective IOP control, significant drug reduction, and fewer postoperative interventions.