360-Degree trabeculotomy beats 180-degree approach

Key Takeaways

  • A study suggests that in surgical treatment for glaucoma, a 360 degree incision to bypass the eye’s drainage system reduced the need for a second surgery compared to a 180-degree approach. 
  • Both surgeries were comparable in their ability to lower intraocular pressure.

Increased pressure in the eye can be caused by a blockage in the trabecular meshwork, part of your eye’s drainage system. A standard surgery for glaucoma is a procedure called a trabeculotomy, which uses an incision to create a small hole in the wall of the eye. The incision allows fluid to escape the eye in a controlled fashion, bypassing the obstructed trabecular meshwork.  Trabeculotomies can differ in the extent of the incision, and the literature has been mixed as to what size of trabeculotomy is best for achieving surgical success. 

A large international, multicenter study has now shown that creating a full-circumference incision around the trabecular meshwork to lower intraocular pressure (IOP) in open-angle glaucoma, a procedure known as 360-degree trabeculotomy, reduced the need for a second operation compared with a 180-degree approach while achieving similar reductions in pressure. The retrospective, consecutive cohort study of 177 eyes of patients with glaucoma aged 40 years and older found that 74.4% of patients in the 360-degree group and 56.3% in the 180-degree group achieved surgical success, Ahmed Abdelaal, MD, a research fellow at Prism Eye Institute in Oakville, Ontario, Canada, reported at the annual meeting of the American Glaucoma Society.  (Criteria for surgical success at 1 year of follow-up were IOP below 18 mmHg and either a reduction in pressure of more than 20% from baseline with the same number of medications or a decline in pressure with fewer medications.) A statistical analysis suggests that the 180-degree patients had more than twice the rate of operation failure, Abdelaal said. Postoperative complications were comparable, he reported. 

Abdelaal noted the limitation of the retrospective study, which did not randomize eyes to the respective procedures. “A prospective, randomized controlled study is needed to better compare the outcomes between 180- and 360-degree trabeculotomy,” said Leo Seibold, MD, a professor of ophthalmology at the University of Colorado School of Medicine, who was not affiliated with the new study. 

Edited by Dawn Wilcox and Miriam Kaplan.

Source: Richard Mark Kirkner, Medscape Medical News, March 05, 2024; see source article