DOI: 10.1097/IJG.0b013e31802d6e3d

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PMID: 17473743

Issn Print: 1057-0829

Publication Date: 2007/03/01


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Techniques for Internal Filtering Surgery in Glaucoma

Brian Alan Francis

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We are responding to a letter from Kevin Taliaferro, BA, regarding our paper titled Development of a novel device (Trabectome) and surgery for open-angle glaucoma.1 It is not our intent to “discredit other novel treatments for increasing aqueous outflow in open-angle glaucoma.” Rather, we wished to present a background of other trabecular surgeries that have been developed but not yet achieved widespread use. In fact, since the publication, trabecular stents and canaloplasty have more recently been introduced.
We regret that at the time of manuscript preparation we did not have access to the citations he mentions, as the most recent2 was published after our article, and the others appeared in the German literature.3,4 The results of the most recent study2 show that excimer laser trabeculotomy (ELT) reduced intraocular pressure (IOP) from a baseline of 24.1±0.7 mm Hg (n=69) to 18.8±0.8 at 1 year (n=37) with a success rate of 46% at 1 year. The number of glaucoma medications at baseline was 1.9±0.1 and at 1 year was 1.8±0.2. When combined with phacoemulsification cataract surgery, the IOP was reduced from 22.4±0.6 (n=57) to 16.4±0.4 (n=35) with a success rate of 66% at 1 year. The authors concluded that “ELT, especially in combination with phacoemulsification, is a new, promising, minimally invasive laser treatment to reduce IOP for at least 1 to 2 years. ELT alone is less effective in IOP reduction.”
It is an exciting time for glaucoma surgery with the development of so many trabecular surgery techniques. We believe that with one or more of these technologies, the concept of internal filtering surgery as a first step in incisional glaucoma surgery will eventually gain wide acceptance.
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