title: Trabectome surgery for primary and secondary open angle glaucomas.
abstract: OBJECTIVE
  In most forms of open angle glaucoma, the trabecular meshwork is the main barrier for aqueous humor outflow, causing elevated intraocular pressure (IOP). The Trabectome is a minimal invasive device for the surgical treatment of open angle glaucoma, particularly eliminating the juxtacanalicular meshwork. This study was conducted to compare the effectiveness and complication profile among different glaucoma subgroups.
  
  
  METHODS
  Single center prospective observational study. There were 557 consecutive eyes of 487 patients included in this study. Trabectome surgery was performed either alone or in combination with cataract surgery. Intraoperative and postoperative complications were documented systematically. Main outcome measures were IOP reduction over time and the preoperative and postoperative number of IOP-lowering medications. Due to subgroup sizes, only data from eyes with primary open angle glaucoma and pseudoexfoliation glaucoma were processed for statistical analysis.
  
  
  RESULTS
  For the 261 eyes classified as primary open angle glaucoma, preoperative IOP was 24 ± 5.5 mmHg (mean ± SD) under 2.1 ± 1.3 IOP-lowering medications. After a mean follow-up of 204 ± 238 days, IOP was reduced to 18 ± 6.1 mmHg, and medication was reduced to 1.2 ± 1.1. For the 173 eyes classified as pseudoexfoliation glaucoma, after a mean follow-up of 200 ± 278 days, IOP was reduced from 25 ± 5.9 mmHg to 18 ± 8.2 mmHg, and medication was reduced from 2.0 ± 1.2 to 1.1 ± 1.1. A Cox proportional hazards model hinted forward superiority of the combined surgery cases (Trabectome + Phaco + intraocular lens) in comparison to Trabectome surgery only in phakic or pseudophakic eyes. No serious complications were observed.
  
  
  CONCLUSIONS
  Minimal invasive glaucoma surgery with the Trabectome seems to be safe and effective. The subgroup analysis of different kinds of open angle glaucomas presented in this study may help in first-line patient selection. The lack of ocular surface alterations makes it a valuable addition to glaucoma surgery.
authors.affiliation: University Eye Hospital, Killianstr. 5, 79106, Freiburg, Germany, jens.jordan@uniklinik-freiburg.de.
authors.forename: Jens F
authors.initials: JF
authors.lastname: Jordan
authors.forename: Thomas
authors.initials: T
authors.lastname: Wecker
authors.forename: Christian
authors.initials: C
authors.lastname: van Oterendorp
authors.forename: Alexandra
authors.initials: A
authors.lastname: Anton
authors.forename: Thomas
authors.initials: T
authors.lastname: Reinhard
authors.forename: Daniel
authors.initials: D
authors.lastname: Boehringer
authors.forename: Matthias
authors.initials: M
authors.lastname: Neuburger
mesh_terms: D000328:Adult; D000368:Aged; D017889:Exfoliation Syndrome / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications; D011446:Prospective Studies; D014065:Tonometry, Ocular; D014129:Trabecular Meshwork / Q000601:surgery*; D014130:Trabeculectomy / Q000379:methods*