Clinical ophthalmology (Auckland, N.Z.) · 2025
Efficacy and Safety of Initial Outflow Reconstruction Using Ab Interno Microhook Trabeculotomy: A Retrospective Study in Secondary Glaucoma.
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Aoyama Yurika, Aihara Makoto, Sakata Rei
Аннотация
PURPOSE: Establishing effective surgical interventions for secondary glaucoma (SG) remains a significant clinical challenge. We evaluated the efficacy and safety of initial outflow reconstruction using ab interno microhook trabeculotomy in patients with SG.
PATIENTS AND METHODS: This retrospective study included 39 eyes from 39 patients who underwent either standalone microhooktrabeculotomy or a combined triple procedure with cataract surgery in 2021. The cohort consisted of 18 eyes with exfoliation glaucoma, 15 with uveitic glaucoma, and 6 with steroid-induced glaucoma. Intraocular pressure (IOP) and glaucoma medication scores were recorded preoperatively and at 1, 3, 6, and 12 months postoperatively. Primary outcomes included the IOP reduction rate at 12 months, assessed using mixed effects analysis, and IOP control over time, analyzed via Kaplan-Meier survival curves (failure defined as < 20% IOP reduction or IOP > 21 mmHg on two consecutive visits). Risk factors for surgical failure were analyzed using Cox proportional hazards models. Furthermore, postoperative complications and the need for additional surgical interventions were evaluated.
RESULTS: The mean patient age was 65.1 ± 13.6 years, with 24 male participants. The mean preoperative IOP was 25.4 ± 9.3 mmHg, and the mean medication score was 4.2 ± 1.3 at 12 months postoperatively; these values significantly decreased to 14.9 mmHg and 3.1, respectively (P < 0.05). The mean IOP reduction rate at 12 months was 32.4%, and the Kaplan-Meier survival rate for IOP control was 60.3%. Cox hazard analysis indicated that older age and pseudophakia were associated with improved postoperative IOP control. The most common complication was anterior chamber hemorrhage (35.9%).
CONCLUSION: Ab interno microhook trabeculotomy may represent an effective initial surgical strategy for lowering IOP and reducing the reliance on glaucoma medications in patients with SG, particularly among older individuals and those with pseudophakia.
PATIENTS AND METHODS: This retrospective study included 39 eyes from 39 patients who underwent either standalone microhooktrabeculotomy or a combined triple procedure with cataract surgery in 2021. The cohort consisted of 18 eyes with exfoliation glaucoma, 15 with uveitic glaucoma, and 6 with steroid-induced glaucoma. Intraocular pressure (IOP) and glaucoma medication scores were recorded preoperatively and at 1, 3, 6, and 12 months postoperatively. Primary outcomes included the IOP reduction rate at 12 months, assessed using mixed effects analysis, and IOP control over time, analyzed via Kaplan-Meier survival curves (failure defined as < 20% IOP reduction or IOP > 21 mmHg on two consecutive visits). Risk factors for surgical failure were analyzed using Cox proportional hazards models. Furthermore, postoperative complications and the need for additional surgical interventions were evaluated.
RESULTS: The mean patient age was 65.1 ± 13.6 years, with 24 male participants. The mean preoperative IOP was 25.4 ± 9.3 mmHg, and the mean medication score was 4.2 ± 1.3 at 12 months postoperatively; these values significantly decreased to 14.9 mmHg and 3.1, respectively (P < 0.05). The mean IOP reduction rate at 12 months was 32.4%, and the Kaplan-Meier survival rate for IOP control was 60.3%. Cox hazard analysis indicated that older age and pseudophakia were associated with improved postoperative IOP control. The most common complication was anterior chamber hemorrhage (35.9%).
CONCLUSION: Ab interno microhook trabeculotomy may represent an effective initial surgical strategy for lowering IOP and reducing the reliance on glaucoma medications in patients with SG, particularly among older individuals and those with pseudophakia.