trabectome outcomes in asians with primary open-angle glaucoma with or without cataract

Trabectome outcomes in Asians with Primary open-Angle Glaucoma

With or Without Cataract

Gifu Red Cross HospitalDepartment of ophthalmology

Masahiro Maeda M.D.

Japanese Red Cross Society

• I have no financial interest


Purpose of this studyTo evaluate the Outcomes of the Trabectome® for Asian Glaucoma Patients with or without Cataract

Main outcomesIntraocular pressure

Medication usage before and after surgery

Complications

Corneal endothelial cell density


Surgical systemJapanese Red Cross Society

The Trabectome system consists of a disposable handpiece with irrigation and aspiration functions as well as an electrocautery unit at its tip.


Method1. 1.7mm temporal clear corneal incision2. Inflate anterior chamber with viscoelastic3. Insert tip into Schlemm’s canal4. Ablate nasal trabecular meshwork5. Reverse ablation

6. In combined case, Cataract extraction and IOL implantation

7. Remove viscoelastic

1

2

3

4

5


Trabectome only Trabectome + PhacoNumber 149 121

Age Mean 61 71STD 20 10Minimum 0 32Maximum 90 90

Gender Males 88 60Females 58 58Not Indicated 3 3

Diagnosis POAG 81 89Pseudoexfoliation (PEX) 15 7 JRA 0 0COAG 2 0Myopic degeneration 0 0Steroid Induced 4 1Pigment Dispersion 2 1Uvetic 1 0Other or not indicated 44 23

Pre-Op Snellen Acuity 20/20 – 20/40 32 1520/50 – 20/70 4 2320/80 – 20/100 9 920/200 - 20/400 6 2<20/400 0 3 NR 98 69

VF Status Minimal 4 2Moderate 35 43Advanced 50 32MD/Other 60 44

Disc C/D (if known) <0.7 28 330.7 through 0.8 84 54>0.8 29 25NR 8 9

Lens Status Psuedophakic 73 0Phakic 66 120Aphakic 1 0Not Indicated 9 1

Shaffer Grade I 1 1II 4 20III 55 52IV 79 42Not Indicated 10 6Ptyerigium 0 1Pediatric (Age 0-21 years) 9 0

Prior Surgeries SLT 16 11ALT 7 3Shunt 0 0Trabeculectomy 6 3Trabectome 3 0Vitrectomy 1 0LI 0 0ECP 0 0Yag 0 0Retina Surgery 1 1CRVO 1 0

Combined Surgeries Trabectome + Phaco 0 121Trabectome + Goniosynechia 0 0Trabectome + shunt 0 0Trabectome + Penetrating Keratoplasty

00

Trabectome + ECP 0 0Trabectome + Bleb Revision 0 0Trabectome ONLY 149 0

Demographics


IOP (mmHg) % Reduction 2nd Surgery RX % Reduction

Avg. STD Avg. No. Cumulative # STD Post-Pre

Pre-op IOP 26.0 7.7 0% 149 3.34 1.22 0%1 day 20.5 10.3 -18% 148 0 3.23 1.39 -3%3 day 19.3 7.4 -22% 146 0 3.23 1.41 -4%1 Week 18.7 7.2 -24% 146 0 3.42 1.38 2%2 Weeks 17.8 6.2 -27% 144 0 3.47 1.31 4%1 month 17.3 5.3 -29% 141 0 3.31 1.32 -1%2 months 17.4 4.8 -28% 130 3 3.21 1.29 -4%3 months 17.7 5.0 -27% 118 5 2.97 1.13 -11%4 months 17.4 4.6 -28% 105 8 2.77 1.15 -17%5 months 17.5 4.7 -28% 97 12 2.71 1.18 -19%6 months 17.5 4.3 -28% 91 12 2.71 1.15 -19%7 months 17.5 4.0 -28% 78 14 2.63 1.26 -21%8 months 17.4 4.3 -31% 69 15 2.54 1.32 -24%9 months 17.4 3.8 -30% 64 15 2.52 1.32 -25%10 months 17.9 4.4 -28% 61 15 2.59 1.28 -23%11 months 17.8 4.2 -28% 54 15 2.67 1.39 -20%12 months 18.0 4.5 -27% 48 17 2.56 1.35 -23%15 months 17.9 6.2 -30% 39 18 2.44 1.33 -27%18 months 17.9 4.9 -31% 25 18 2.48 1.26 -26%21 months 18.0 4.5 -31% 19 20 2.95 1.18 -12%24 months 16.8 4.8 -35% 11 21 2.73 1.42 -18%30 months 13.8 2.6 -35% 5 21 3.00 0.71 -10%36 months 16.0 -33% 1 21 3.00 -10%40 months 14.0 -42% 1 21 3.00 -10%44 months 12.5 -48% 1 21 4.00 20%Total Mean 17.2 5.1 -30% 2.9 1.3 -14%

COMPLETE DATABASE - ASIANS - TRABECTOME ONLY

IOP and Rx


IOP (mmHg) % Reduction 2nd Surgery RX % Reduction

Avg. STD Avg. No. Cumulative # STD Post-Pre

Pre-op IOP 21.2 7.3 0% 121 1.12 0%1 day 19.2 9.4 -4% 118 0 2.71 1.33 8%3 day 17.8 6.4 -9% 115 0 2.78 1.30 11%1 Week 16.7 6.3 -14% 115 0 2.89 1.30 15%2 Weeks 15.6 5.6 -22% 113 0 2.92 1.25 17%1 month 14.9 4.6 -25% 109 0 2.82 1.19 12%2 months 14.9 4.1 -24% 106 0 2.46 1.20 -2%3 months 14.8 3.8 -24% 104 0 2.22 1.19 -11%4 months 14.9 3.5 -22% 97 0 2.03 1.21 -19%5 months 14.8 3.4 -21% 90 0 1.96 1.15 -22%6 months 15.0 3.4 -21% 82 0 1.87 1.17 -25%7 months 15.6 3.6 -18% 79 0 1.80 1.18 -28%8 months 15.6 3.5 -18% 76 0 1.82 1.22 -27%9 months 15.3 3.2 -19% 71 0 1.82 1.16 -27%10 months 15.5 3.2 -19% 68 0 1.79 1.24 -28%11 months 15.9 3.3 -16% 62 1 1.82 1.25 -27%12 months 16.6 3.6 -15% 56 1 1.89 1.29 -24%15 months 16.3 4.2 -16% 50 1 1.98 1.32 -21%18 months 16.5 3.4 -17% 29 1 2.31 1.37 -8%21 months 16.6 3.3 -8% 23 1 2.09 1.16 -17%24 months 15.3 2.5 -14% 8 1 2.38 0.92 -5%30 months 15.4 3.7 -18% 7 1 2.71 1.11 8%36 months 17.0 4.8 -21% 4 1 2.00 1.41 -20%40 months 15.3 2.8 -12% 3 1 1.67 0.58 -33%44 months 14.0 -30% 1 1 2.00 -20%Total Mean 15.8 4.2 -18% 2.2 1.2 -12%

COMPLETE DATABASE - ASIANS - TRABECTOME + Phaco

IOP and Rx


Trabectome only Trabectome + Phaco


Corneal endothelial cell density

statistically NO significant difference: Paired t testTrabectome only (pre: 2406(n=77), 6M: 2334(n=44))Trabectome+Phaco (pre: 2598(n=76), 6M: 2568(n=44))


Trabectome only Trabectome + PhacoTotal number of Patients 149 121Trabeculectomy post Trabectome 12 0Shunt post Trabectome 4 0Diode Cyclo Photo Coagulation 1 0SLT post Trabectome 0 0Phaco post Trabectome 0 0ECP post Trabectome 0 0Trabectome post Trabectome (patient request) 4 1Tube Ligature Release on combined Tube and Trabectome 0 0Total Secondary Surgery 21 1Eyes out of Study due to patient move - no follow up record 3 0Eyes out of study due to patients death (not related to Trabectome procedure) 2 1Sustained Hypotony (IOP < 5 mmHg) one month post op 0 0Hypotony (IOP < 5 mmHg) one day post op 1 0IOP-1D > 10 mmHg from pre op IOP 15 14Aqueous Misdirection 0 0Infection 0 0Bleb Formation 0 0Wound Leaks 0 0Problematic Pain 0 0Choroidal Effusion 0 0Choroidal Hemorrhage 0 0Visual Acuity Decrease (> 2 lines) 0 0Combination Phaco+Trabectome 0 121Combination Shunt+Trabectome 0 0Pediatric (Infantile and Juvenile Age range 0 to 21 years) 9 0Intra Operative Blood Reflux: Yes 120 118 No 9 3 not reported 20 0

Complications

No serious vision threatening complication

Trabectome, Ab interno trabeculotomy, is ・・・

• effective without any serious complications.• safe procedure for Asian glaucoma patients to

reduce IOP.

But, of course,• do not expect extremely low IOP

Acknowledgement

Trabectome Study Group


Conclusion

trabectome outcomes in asians with primary open-angle glaucoma with or without cataract

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