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External Trabeculotomy Offers Fewer Complications Than Trabeculectomy for Treating Steroid-Induced Glaucoma: Presented at AAO-PAAO

By Fred Gebhart

SAN FRANCISCO -- October 28, 2009 -- External trabeculotomy (TLO) offers a lower risk of complications over regular trabeculectomy (TLE) as a treatment for steroid-induced glaucoma, according to new data presented here at the 2009 Joint Meeting of the American Association of Ophthalmology and Pan-American Association of Ophthalmology (AAO-PAAO).

Few trials directly compare either the results or the effects of TLO and TLE, both of which can be effective in reducing intraocular pressure. TLE presently is used more often.

Steroid-induced glaucoma is a common form of secondary open-angle glaucoma. It is most often associated with topical application of corticosteroids, noted lead author Nobuo Fuse, MD, Tohoku University Graduate School of Medicine, Sendai, Japan, speaking here on October 25. Steroid-induced glaucoma is also seen in patients on systemic steroid therapy for a variety of conditions.

Dr. Fuse and fellow researchers conducted a retrospective study of consecutive patients with steroid-induced glaucoma at the Tohoku University Hospital Glaucoma Service, Tokyo, Japan. The series included 41 eyes and 41 patients, 20 of whom received TLO and 21 of whom received TLE. Clinical outcomes were evaluated at 1, 2, 3, 6, and 12 months postoperatively. Each follow-up visit included Goldmann applanation tonometry, best corrected visual acuity, and fundus examination.

Eyes in the study were statistically similar at baseline in terms of age, refraction, visual acuity, maximum intraocular pressure, intraocular pressure before surgery, and eye-drop score. Both procedures produced statistically similar results at 12 months post surgery, with a 100% intraocular-pressure control for TLE and 90% control for TLO (P = .14). The mean postoperative intraocular pressure for the TLO group was 15.3 mm Hg (compared with a mean of 33.4 mm Hg before surgery) and 8.6 mm Hg for the TLE group (compared with a mean of 33.1 mm Hg before surgery) (P = .001).

The TLE group also had a 14% complication rate, however, researchers noted, with 2 eyes that developed hypotensive maculopathy and 1 case of blebitis. There were no complications in the TLO group.

The difference in complication rates led the researchers to conclude that TLO is the preferred procedure because of the statistically similar intraocular pressure outcomes and the significantly lower rate of adverse events.

[Presentation title: Evaluation of External Trabeculotomy and Trabeculectomy for Treatment of Steroid-Induced Glaucoma. Abstract PO114]

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