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      Ab-interno trabeculotomy-related glaucoma surgeries

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          Abstract

          Reductions of intraocular pressure during trabeculotomy result from relieving the resistance to aqueous flow by cleavage of the trabecular meshwork and inner walls of Schlemm's canal at the point of outflow resistance of the aqueous humor. Since trabeculotomy does not result in bleb formation, development of late-onset sight-threatening complications, such as hypotony maculopathy and endophthalmitis, that are associated occasionally with trabeculectomy develop less frequently after trabeculotomy. The ab-interno approach is used in several new procedures, including the Trabectome, Kahook Dual Blade, microhook abinterno trabeculotomy, and 360° suture trabeculotomy, instead of the ab-externo approach as in conventional trabeculotomy. These newly developed novel, minimally invasive, and trabeculotomy-related glaucoma surgeries can be good options for certain glaucoma cases, including early-stage open-angle glaucoma, developmental glaucoma, and glaucoma in elderly patients.

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          Most cited references19

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          Outflow resistance of enucleated human eyes at two different perfusion pressures and different extents of trabeculotomy.

          Aqueous outflow resistance of enucleated human eyes was measured at 7 and 25 mm Hg before and after partial and complete (12 clock hours) internal trabeculotomy. Following complete trabeculotomy, 71% of the resistance was eliminated at 25 mm Hg while only 49% was eliminated at 7 mm Hg. In contrast to published findings in eyes with intact trabecular meshwork where the resistance increased with increasing IOP (1), following complete trabeculotomy, the resistance decreased 2% per mm Hg with increasing IOP. Experiments with trabeculotomy limited to part of the circumference showed that a one hour trabeculotomy produced 41% (25 mm Hg) to 60% (7 mm Hg) of the effect of a twelve hour trabeculotomy. The results indicate that a surprisingly high fraction of aqueous outflow resistance resides in the distal aspects of the outflow system at normal IOP, and that this distal resistance drops as IOP is increased.
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            Clinical results with the Trabectome for treatment of open-angle glaucoma.

            To describe clinical results from a pilot study of a novel glaucoma surgical device. Prospective interventional case series. Thirty-seven adult Hispanic and Caucasian patients (17 male, 20 female) with uncontrolled open-angle glaucoma (OAG) in one or both eyes with or without previous surgery or laser treatment were recruited from a clinical practice in Tijuana, Mexico. Surgery was performed with the Trabectome (NeoMedix Corp., San Juan Capistrano, CA) in one eye of each patient. Goldmann applanation intraocular pressures and Snellen visual acuities were measured before and after surgery. Intraoperative and postoperative adverse events were tabulated, and numbers of preoperative and postoperative adjunctive medications were compared before and after surgery. Preoperative pressures after 1 week of medication washout averaged 28.2+/-4.4 mmHg (n = 37). Only 3 patients were not using topical medications preoperatively. Follow-up ranged between 3 months (n = 37) and 13 months (n = 11). Mean postoperative IOPs were 18.4+/-10.9 mmHg (n = 37) at 1 day, 17.5+/-5.9 mmHg (n = 37) at 1 week, 17.4+/-3.5 mmHg (n = 25) at 6 months, and 16.3+/-2.0 mmHg (n = 15) at 12 months. Visions returned to within 2 lines of preoperative levels and remained stable in all patients beyond 3 weeks postoperatively except one, not sutured at surgery, who had a late hyphema probably associated with corneal wound gaping after accidental blunt trauma. The number of adjunctive medications decreased from 1.2+/-0.6 among preoperative patients on medications (n = 34) to 0.4+/-0.6 among all patients at 6 months (n = 25). Blood reflux occurred in all eyes on instrument withdrawal after angle surgery and was present at day 1 in 22 eyes (59%) with clearing by slit-lamp examination at a mean of 6.4+/-4.1 days postoperatively. The Trabectome seems to offer a safe and effective method of lowering IOP in OAG.
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              Short-term results of microhook ab interno trabeculotomy, a novel minimally invasive glaucoma surgery in Japanese eyes: initial case series.

              To report the first early postoperative results and safety profile after microhook ab interno trabeculotomy (μLOT).
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                Author and article information

                Journal
                Taiwan J Ophthalmol
                Taiwan J Ophthalmol
                TJO
                Taiwan Journal of Ophthalmology
                Wolters Kluwer - Medknow (India )
                2211-5056
                2211-5072
                Apr-Jun 2019
                : 9
                : 2
                : 67-71
                Affiliations
                [1] Department of Ophthalmology, Faculty of Medicine, Shimane University, Shimane Prefecture, Japan
                Author notes
                Address for correspondence: Prof. Masaki Tanito, Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, 693-8501, Shimane Prefecture, Japan. E-mail: tanito-oph@ 123456umin.ac.jp
                Article
                TJO-9-67
                10.4103/tjo.tjo_38_19
                6557068
                31198665
                28d76499-3fbf-43d0-a99f-9caeff0a84e4
                Copyright: © 2019 Taiwan J Ophthalmol

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 29 March 2019
                : 11 April 2019
                Categories
                Review Article

                ab-externo trabeculotomy,kahook dual blade,microhook ab-interno trabeculotomy,minimally invasive glaucoma surgery,suture ab-interno trabeculotomy,trabectome

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