Subject(s)
Filtering Surgery , Glaucoma, Open-Angle/surgery , Adult , Aged , Aged, 80 and over , Conjunctiva/surgery , Female , Glaucoma, Open-Angle/physiopathology , Humans , Intraocular Pressure/physiology , Male , Middle Aged , Retrospective Studies , Sclera/surgery , Surgical Flaps , Suture Techniques , Tonometry, Ocular , Trabecular Meshwork/surgery , Treatment OutcomeABSTRACT
PURPOSE: To investigate the safety and efficacy of intraoperative conversion of unsuccessful canaloplasty technique into 180-degree metal or 360-degree suture trabeculotomy. METHODS: In this retrospective observational case series, 35 eyes of 35 patients with open-angle glaucoma (OAG) who had undergone unsuccessful canaloplasty technique and underwent intraoperative conversion were studied. In 17 eyes (group A), the procedure was converted into 180-degree metal trabeculotomy because of unsuccessful circumferential Schlemm's canal (SC) catheterisation. Group B included 18 eyes that were converted into 360-degree trabeculotomy because of cheese wiring of tension suture through the trabecular meshwork (TM) after successful complete catheterisation of SC. RESULTS: Median preoperative IOP was 22.0 mmHg (range 16-34) in group A, and 22.0 mmHg (range 15-48) in group B. Median IOP was significantly reduced in both groups postoperatively, at the 12-month examination to 15.0 mmHg (range 9-21) representing a reduction of 36 % in group A, and to 14.5 mmHg (range 8-21) representing a reduction of 34 % in group B. Median glaucoma medication number decreased significantly from 4 (range 2-4) and 3 (range 1-4) preoperatively to 2 (range 0-4) and 1 (range 0-3) at 12 months in groups A and B respectively. Hyphema was the commonest complication, with an incidence of 76 % in group A and 78 % in group B. CONCLUSION: 180-degree metal or 360-degree suture/catheter trabeculotomy are safe and effective surgical backup methods to control IOP in cases of unsuccessful intracanalicular placement of tension suture during canaloplasty surgery.
Subject(s)
Catheterization , Glaucoma, Open-Angle/surgery , Limbus Corneae/surgery , Trabecular Meshwork/surgery , Trabeculectomy/methods , Adult , Aged , Aged, 80 and over , Aqueous Humor/metabolism , Female , Glaucoma, Open-Angle/physiopathology , Humans , Intraocular Pressure/physiology , Intraoperative Period , Male , Middle Aged , Retrospective Studies , Suture Techniques , Visual Acuity/physiology , Young AdultABSTRACT
BACKGROUND: In this study, a conjunctival-sparing ab interno approach for circumferential trabeculotomy, termed micro-invasive suture trabeculotomy (MIST) and its preliminary results are presented. DESIGN: Retrospective case-series in a university setting. PARTICIPANTS: A total of 31 patients with open-angle glaucoma with history of canaloplasty. METHODS: A conjunctival-sparing ab interno approach for circumferential trabeculotomy, termed MIST. MAIN OUTCOME MEASURES: Mean decrease of intraocular pressure (IOP) and number of pressure-lowering medications. RESULTS: Mean decrease of IOP was 11.1 mmHg (standard deviation [SD], 9.9 mmHg) at 6 months, 12.1 mmHg (SD, 10.5 mmHg) at 12 months and 13.5 mmHg (SD, 11.4 mmHg) at 24 months. The average percent lowering of IOP was 36.7% (SD, 32.8%) at 6 months, 41.4% (SD, 35.9%) at 12 months and 44.6% (SD, 37.7%) at 24 months. The number of pressure-lowering medications decreased by 1.1 (SD, 1.3) at month 6, by 1.2 (SD, 1.5) at month 12, and by 1.3 (SD, 1.6) at month 24. CONCLUSIONS: MIST is a promising approach for the treatment of open-angle glaucoma, which is insufficiently controlled with canaloplasty. The procedure achieved significant and sustained lowering of the intraocular pressure and demonstrated an excellent safety profile. The main advantages of the procedure are: easy to learn, fast to perform, and sparing of the conjunctiva for further filtration surgery, if necessary.
