Outcomes of Full 360-Degree Versus 180-Degree Trabeculotomy Without Phacoemulsification: An International Multicentre Study

Theme: Glaucoma
What: Glaucoma
Part of: Glaucoma II: Surgery / Glaucome II: Chirurgical
When: 5/31/2024, 02:00 PM - 03:30 PM
Where: Room | Salle 801

Abstract

Purpose: To evaluate the effectiveness and safety of 360° trabeculotomy versus 180° trabeculotomy. 360° opens the entire trabecular meshwork,¹ which may be unnecessary or of little benefit over opening 180°.²

Study Design: Multicentre, consecutive, retrospective cohort study.

Methods: Consecutive patients >40 years old undergoing either 360° or 180° trabeculotomy without phacoemulsification, at one of 9 participating centres (Canada, Turkey, Japan) between June 2015 and November 2021 were compared. Primary outcome was surgical success (primary success) at 1 year follow-up, defined as IOP <18mmHg, and 1) ≥20% IOP reduction from baseline on same number of medications, or 2) IOP ≤ baseline on fewer medications. Secondary outcomes included complete success (no medications allowed) and qualified success (medications allowed) at IOP threshold of 17 mmHg, post-operative IOP, medication use, complications, interventions, and reoperations.

Results: A total of 263 eyes were included (360° group: n=154; 180° group: n=109). Eyes in the 360° group had a significantly higher baseline median IOP of 24mmHg (IQR 19.50-32.00) on 3 medication classes compared to 21mmHg (IQR 17.00-27.75) on 3 classes in the 180° group (P < 0.01). Other baseline characteristics showed no difference between groups. After 1 year follow-up, the 360° group demonstrated a significantly higher primary success rate than 180° (49.4% vs. 29.1%; P = 0.002). The crude hazard ratio of failure for 180° relative to 360° trabeculotomy was 1.72 (95% CI 1.20-2.45). Complete success showed no significant difference between groups (P = 0.28), although qualified success favored the 360° group (42.5% vs. 27.8%; P = 0.008). At 12 months, mean post-operative IOP in the 360° group was 14.86mmHg (±5.76) on 1.56 (±1.45) classes compared to 14.3mmHg (±6.21) on 1.55 (±1.438) classes for the 180° group. Post-operative complications were generally higher in the 360° group, with hyphema ≥2mm (22.7% vs 3.7%; P < 0.001), severe corneal edema (5.2% vs 0%; P = 0.023), and macular edema (3.9% vs. 0%; P = 0.043) occurring at a significantly higher rate compared to the 180° trabeculotomy group. Reoperation rates were similar between groups (360°: 25.97%; 180°: 25.69%; P > 0.05).

Conclusions: This international multicentre study provides evidence for the efficacy of full 360° trabeculotomy without phacoemulsification, demonstrating higher surgical success and IOP-lowering effect at one year post-operatively than the 180° trabeculotomy group. However, this benefit should be carefully weighed against the significantly higher risk of post-operative hyphema, corneal edema, and macular edema.

Presenter(s)

Presenting Author: Ahmed Abdelaal

Additional Author(s):

Jeb Ong, Hôpital Saint-Sacrement

Matthew Schlenker, Prism Eye Institute

Ike Ahmed, Prism Eye Institute

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