Trabekulotomie ab interno (Trabectome) – Kumulierte klinische Ergebnisse eines großen Glaukomkollektivs

 

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Zusammenfassung

Hintergrund: Das Ziel der Studie war es, den drucksenkenden Effekt und die Reduktion der antiglaukomatösen Therapie durch die Trabekulotomie ab interno (Trabectome) zu evaluieren und die Einsatzmöglichkeit im klinischen Alltag zu bewerten. Patienten und Methoden: 296 Augen (n = 296 Patienten) mit diagnostiziertem primärem Offenwinkelglaukom (PCOWG) und Pseudoexfoliationsglaukom (PEX) wurden in die Studie von 06/2012 bis 06/2014 eingeschlossen. Bei zeitgleichem Vorliegen einer Katarakt wurde die Trabectomeoperation mit einer Phakoemulsifikation (Phako) und IOL-Implantation kombiniert. Zur statistischen Auswertung wurden 4 Gruppen gebildet (Gruppe 1 = Trabectome bei PCOWG, Gruppe 2 = Trabectome bei PEX, Gruppe 3 = Trabectome + Phako bei PCOWG, Gruppe 4 = Trabectome + Phako bei PEX). IOD-Messungen und die Zahl der antiglaukomatösen Medikation wurde bei jedem Follow-up über 1 Jahr erhoben. Ergebnisse: In Gruppe 1 und 2 betrug der mittlere IOD präoperativ 19,8 ± 5,9 mmHg und 23,7 ± 9,5 mmHg. Es zeigte sich eine signifikante IOD-Reduktion auf 14,8 ± 3,2 mmHg (p = 0,001) und 14,0 ± 3,3 mmHg (p = 0,046) 1 Jahr postoperativ. Die Anzahl der topischen Glaukommedikamente sank auf 2,1 ± 1,2 (p = 0,004) und 2,4 ± 1,2 (p = 0,593) nach 1 Jahr Follow-up in Gruppe 1 und 2. Der mittlere IOD präoperativ betrug 19,2 ± 4,0 mmHg und 23,2 ± 9,2 mmHg in der Gruppe 3 und 4. Eine signifikante IOD-Reduktion auf 11,8 ± 3,1 mmHg (p < 0,01) und 12,6 ± 1,1 mmHg (p = 0,043) zeigte sich 1 Jahr postoperativ. Die Anzahl der topischen Glaukommedikamente änderte sich auf 2,3 ± 1,4 (p = 0,469) und 1,4 ± 0,8 (p = 0,102) nach 1 Jahr Follow-up, jeweils für das PCOWG und PEX. In der Gruppe Trabectome + Phako PCOWG in Korrelation zur Gruppe Trabectome PCOWG konnte ein signifikanter Unterschied bez. der IOD-Senkung nach 1 Jahr postoperativ (p = 0,017) erhoben werden. In der Gruppe Trabectome + Phako PEX vs. Gruppe Trabectome PEX konnte kein signifikanter Unterschied (p = 0,678) demonstriert werden. Es traten keine schwerwiegenden postoperativen Komplikationen auf. Schlussfolgerung: Die Trabekulotomie ab interno (Trabectome) konnte eine signifikante Drucksenkung nach 1 Jahr Nachuntersuchung in allen Subgruppen erzielen. Aufgrund des geringen Nebenwirkungsspektrums kann das Trabectome als zuverlässiges und komplikationsarmes Verfahren zur IOD-Reduktion bei milden und moderaten Glaukomstadien im Klinikalltag eingesetzt werden.

Abstract

Background: To assess the outcome of routine trabectomy surgery in the treatment of primary (POAG) and secondary open angle glaucoma. Patients/Methods: 296 eyes of 296 patients with diagnosed open angle glaucoma and exfoliative glaucoma were analysed from June 2012 until June 2014. IOP readings (intraocular pressure) and the number of antiglaucoma medications was evaluated at every follow-up visit. For statistical analysis, 4 study cohorts were built (cohort 1 = trabectomy in POAG, cohort 2 = trabectomy in exfoliative glaucoma (PEX), cohort 3 = trabectomy + IOL in POAG, cohort 4 = trabectomy + IOL in PEX glaucoma). Results: Mean IOP before trabectomy surgery was 19.8 ± 5.9 mmHg and 23.7 ± 9.5 mmHg in cohorts 1 and 2, respectively. At 1 year follow-up, IOP was reduced to normal level for cohorts 1 and 2 (14.8 ± 3.2 mmHg (p = 0.001) and 14.0 ± 3.3 mmHg (p = 0.046), respectively). The number of topical antiglaucoma medications changed to 2.1 ± 1.2 (p = 0.004) and 2.4 ± 1.2, respectively (p = 0.593) at one year follow-up, respectively, for POAG and exfoliative glaucoma. In study cohort 3 and 4, mean IOP before trabectomy surgery was 19.2 ± 4.0 mmHg and 23.2 ± 9.2 mmHg, respectively. At 1 year follow-up, IOP was reduced to normal levels in cohorts 3 and 4 (11.8 ± 3.1 mmHg (p < 0.01) and 12.6 ± 1.1 mmHg, respectively (p = 0.043)); the number of topical antiglaucoma medications changed to 2.3 ± 1.4 (p = 0.469) and 1.4 ± 0.8, respectively, (p = 0.102) at 1 year follow-up. A significant difference in IOP reduction could be demonstrated in POAG between the trabectomy + IOL group and the trabectomy cohort 1 year postoperative (p = 0.017); in the PEX trabectomy + IOL versus PEX trabectomy cohort no statistically significant difference (p = 0.678) could be demonstrated. No serious postoperative complications were recorded. Conclusion: Trabectomy surgery seemed to be a reliable and effective tool for the management of mild and moderate primary and secondary open angle glaucoma with uncontrolled IOP in daily routine. One year follow-up showed a significant reduction in intraocular pressure in all cohorts.

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