Goniopuncture in the Treatment of Short-term Post-Trabectome Intraocular Pressure Elevation

A Retrospective Case Series Study

Qianqian Wang, MDCM; Paul Harasymowycz, MD, MSc

Disclosures

J Glaucoma. 2013;22(8):e17-e20. 

In This Article

Abstract and Introduction

Abstract

Purpose: This study characterizes patients with post-Trabectome intraocular pressure (IOP) elevation induced by membrane growth and/or peripheral anterior synechiae and examines the results of Nd:YAG goniopuncture as its treatment.

Methods: All Trabectome cases received standard postoperative care and no pilocarpine was given. Two groups were identified: (1) Trabectome-goniopuncture (TG) and (2) Trabectome alone (without goniopuncture) (TA). IOP and number of glaucoma medications (NGM) were collected by retrospective review. Information on whether cataract extraction was combined to the Trabectome was also recorded.

Results: In TG group (n=8), pre-Trabectome IOP and NGM were 16.9±3.7 mm Hg and 2.5±1.0, respectively. IOP rose to 21.9±2.9 mm Hg before goniopuncture (P=0.03) but lowered to 16.1±4.8 mm Hg after the treatment (P=0.006). IOP reduction persisted at post-Trabectome 3 months (13.5±1.5 mm Hg), 6.5 months (15.3±9.3 mm Hg), and 10.5 months (13.4±1.0 mm Hg). No significant medication reduction was detected. In TA group (n=22), pre-Trabectome IOP and NGM were 18.1±2.5 mm Hg and 2.7±0.5, respectively. NGM was significantly lowered from post-Trabectome day 1 on (1.8±0.6, P=0.01) and IOP from 3 months on (15.2±1.8 mm Hg, P=0.03). Five (62.5%) TG cases and 18 (81.5%) TA cases underwent combined cataract extraction-Trabectome. Compared with the TA group, TG cases are associated with thinner pachymetry (P=0.034).

Conclusions: Cleft closure may cause post-Trabectome pressure elevation. Not providing any medication-sparing effect, goniopuncture is, however, effective in lysing these closures and in normalizing the IOP back to its pre-Trabectome level.

Introduction

The Trabectome is a novel minimally invasive surgical technique to treat open-angle glaucoma. This technique enhances the natural aqueous outflow by partially unroofing inner Schlemm canal with microelectrocautery.[1] It may decrease number of glaucoma medications (NGM) and reduce intraocular pressure (IOP) to the mid-teens.[1]

Nd:YAG laser goniopuncture has been widely used to increase surgical success of nonpenetrating glaucoma surgery by puncturing the trabeculo-Descemet membrane.[2]

Our group observed short-term (≤2 mo) postoperative IOP elevation in patients who had undergone either combined cataract extraction (CE)-Trabectome or Trabectome alone (TA). The surgical clefts of these cases were closed by membrane growth and/or peripheral anterior synechiae (PAS), which were then lysed by goniopuncture. This study aims to describe these patients and to follow their response to goniopuncture through comparison with cases that did not require the laser treatment.

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