Combined Ab-Interno Trabeculectomy and Trabecular Aspiration as a Simultaneous versus Sequential Addition to Phacoemulsification in Exfoliative Eyes.

Abstract

Purpose: To determine differing outcomes among pseudophakic patients with exfoliation glaucoma who underwent combined trabectome surgery and trabecular aspiration and phakic patients treated by a triple procedure with additional phacoemulsification.

Methods: This retrospective study involved 75 eyes of 75 participants, of which 25 eyes received combined ab-interno trabeculectomy and trabecular aspiration (Trabectome + TA group), and 50 eyes underwent a triple procedure with additional phacoemulsification (triple group). The groups were matched at a 1:2 ratio, based on the following criteria: preoperative intraocular pressure (IOP), maximum known preoperative IOP, preoperative medication score, cup/disc ratio, follow-up time, and age. Successful surgery was defined by three scores: IOP at longest follow-up <21 mmHg (Score A) or <18 mmHg (Score B), without re-surgery and an IOP reduction >20% or IOP ≤15 mmHg without re-surgery and an IOP reduction ≥40% (Score C).

Results: The preoperative IOP was 23.7 ± 5 mmHg, respectively, and decreased to 15.2 ± 4 mmHg in the triple group, which is significantly lower than postoperative IOP in the Trabectome + TA group, being 18.6 ± 8 mmHg during an average follow-up period of 33.4 ± 26 months (P = 0.02). The success rate in the triple group was significantly higher than in the Trabectome + TA group, according to Score A (78% vs. 40%) and Score B (70% vs. 36%). When aiming at a lower target IOP (Score C), the success rates did not differ significantly (36% vs. 24%).

Conclusions: Cataract extraction, as a part of a triple procedure, seems to contribute to more effective IOP-lowering than trabectome surgery and trabecular aspiration alone in patients who underwent standalone phacoemulsification previously.