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Ab interno trabeculotomy effective in childhood glaucoma

Single-incision ab interno trabeculotomy is an effective and safe treatment for paediatric glaucoma patients, according to a new US study.

Led by paediatric ophthalmologist Dr Raymond Areaux, from the University of Minnesota Health paediatric in Minneapolis, the multicentre retrospective interventional case series involved 46 eyes with childhood glaucoma.

Each underwent trabeculotomy using the Trab360 device, by Sight Sciences, inserted by one of four surgeons at four academic medical centres with at least three months of follow-up

Success of the surgery was defined by postoperative intraocular pressure (IOP) of 24 mm Hg or less, with or without medications, with no additional IOP-lowering surgeries.

They found 67% of eyes with childhood successfully met this endpoint, according to Healio/OSN. Mean preoperative IOP was 30.9 mm Hg, and mean follow-up was 16.2 months.

“We concluded that single-incision ab interno trabeculotomy is effective and safe for treating pediatric glaucomas, especially primary congenital glaucoma. Good surgical technique and caution in high-risk angles is imperative to avoid cyclodialysis,” study co- Areaux said.

Additionally, in 40 eyes for which Trab360 was the first glaucoma surgery, success was achieved in 70% of cases. Surgery was successful in 81% of 21 eyes with primary congenital glaucoma. In 18 eyes with primary congenital glaucoma first treated with Trab360, the success rate was 83.3%.

In the subgroup of successful eyes, the mean IOP decrease was 13.65 mm Hg with a mean 1.3 glaucoma medications used at a mean follow-up of 15.3 months.

Fifteen eyes failed because they needed additional IOP-lowering surgery for uncontrolled glaucoma or surgery due to complications. Two eyes experienced hypotony due to intraoperative cyclodialysis cleft formation.

According to Sight Sciences, the Trab360 trabeculotomy procedure involves the ab interno cutting of up to all 360 degrees of trabecular meshwork to reduce IOP. It can be completed from a single, self-sealing, clear corneal incision. This less invasive approach spares the conjunctiva and sclera of any incisions.