Surgical effects of trabeculotomy ab externo on adult eyes with primary open angle glaucoma and pseudoexfoliation syndrome
H. Tanihara, A. Negi, M. Akimoto, H. Terauchi, A. Okudaira, J. Kozaki, A. Takeuchi and M. Nagata
Department of Ophthalmology, Tenri Hospital, Nara, Japan.
OBJECTIVES: Retrospective and prospective studies examined the surgical
effects in lowering intraocular pressure levels of trabeculotomy ab externo
in adult eyes with either primary open angle glaucoma or pseudoexfoliation
syndrome. We report the results of primary trabeculotomy as an intervention
for glaucoma. PATIENTS: Included in the retrospective study were 357 eyes
of 227 patients with primary open angle glaucoma and 82 eyes of 65 patients
with pseudoexfoliation syndrome, each of which underwent trabeculotomy ab
externo alone and none of which had a history of laser or surgical
treatment for ocular disease. Included in the prospective study were 33
eyes of 22 patients with primary open angle glaucoma and 17 eyes of 15
patients (older than 40 years) with pseudoexfoliation syndrome. RESULTS: A
life-table analysis for the retrospective study showed that the final
success probability (mean +/- SE) at 5 years after surgery was 73.5% +/-
6.3% in eyes with pseudoexfoliation syndrome, which is significantly better
than 58.0% +/- 3.1% in eyes with primary open angle glaucoma (P < .05).
Also, the higher the preoperative intraocular pressure levels are, the less
likely that the postoperative intraocular pressure levels will be brought
under control (P < .01). Surgical outcome in the prospective study
demonstrated success in 27 (79%) of 34 eyes after 3 years and in 16 (64%)
of 25 eyes after 5 years, with medication. Complications included
Descemet's membrane detachment (one eye), cyclodialysis (one eye), and
decreased visual acuity due to progression of cataract (four eyes).
CONCLUSION: The surgical results of trabeculotomy ab externo remain
effective in controlling intraocular pressure levels for a long time in
selected patients. It thus appears that trabeculotomy ab externo can be
considered as an alternative choice of surgical treatment in some cases of
glaucoma.
