Trabeculotomy ab interno in combined cataract and glaucoma surgery. Results of the optimization

PURPOSE: To present the results of the optimization of ab interno trabeculotomy technology in combined cataract and glaucoma surgery, developed at IRTC “Eye Microsurgery” Ekaterinburg Center.

MATERIALS AND METHODS: The study included a retrospective analysis of the results of three homogeneous groups of patients with various modifications of trabeculotomy as the technology developed from 2007 to 2020. The first group included 87 patients (100 eyes) with an extensive continuous dissection of the trabeculae from 90 to 120 degrees. The method was performed from the year 2009 to 2011. Results of at least five years were analyzed. The second group consisted of 82 patients (90 eyes) who had selective trabeculotomy performed. The method was developed in 2010. A dissection in length was not more than 40°. The cases from years 2011-2013 were analyzed for five years. The third group, consisting of 105 eyes of 96 patients, was operated since 2017 using the technology of microinvasive irrigation trabeculotomy. The length of the dissection of the scleral sinus did not exceed 3-5 degrees (1.5-2 mm). The hypotensive effect was evaluated for up to three years.

RESULTS: Analysis of the long-term results of three groups of patients showed the high efficiency of the used trabeculotomy modifications. Intraocular pressure decreased in the first group from 29±3.4 to 20±2.8 mm Hg (32%), from 26.2±2.7 to 18±2.4 mm Hg (31%) in the second, from 27.0±4.1 to 19.3±3.1 mm Hg (30%) in the third. Reducing the length of the dissection of the scleral sinus and ensuring the tightness of the corneal incisions made it possible to reduce the number of early postoperative complications by almost an order of magnitude (p< 0.01). A temporary decline in vision during the first days after surgery was detected in 32% patients of the first group, 14% of the second, and 3% of the third. The hypotensive effect (IOP< 21 mm Hg), despite a decrease in the length of the opening of the Schlemm canal, did not differ significantly in all analyzed groups 75%, 78%, 77% (p>0.05).

CONCLUSIONS: The developed ab interno trabeculotomy modifications in combined cataract and glaucoma surgery have been shown to be highly effective. Ensuring high tightness of corneal incisions significantly reduces the number of early hemorrhagic complications. Reducing the length of the opening of the scleral sinus to 1.5-2 mm does not affect the long-term functional and hypotensive effect but reduces the level of intraoperative and postoperative complications. The proposed modifications are effective, safe, cost-effective, and can be recommended for combined surgery of glaucoma and cataract.

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