Modified goniotomy as an alternative to trabectome in primary open angle glaucoma and pseudoexfoliation glaucoma: 1 year results

Objective: To assess the outcome of modified goniotomy and trabeculotomy ab interno(Trabectome) surgery in adult primary open angle glaucoma( POAG) and pseudoexfoliation( PEX) glaucoma. Design: Retrospective cohort outcome study. Participants: Two hundred and thirty-six eyes of 236 patients. Methods: This cohort outcome study included 68 POAG(meanage: 65.7 +/- 16.0 years) and 22 PEX glaucoma patients (meanage: 78.3 +/- 7.9 years) in the modified goniotomy cohort and 119 POAG (meanage: 73.9 +/- 9.6 years) and 27 PEX glaucoma patients (mean age: 75.2 +/- 8.0 years) in the Trabectome cohort. Modified goniotomy is defined as combined ab interno cyclodialysis and goniotomy. The patients were followed up for 12 months, and we analysed the data using SPSS v19.0. Results: In POAG, the intraocular pressure(IOP) was significantly reduced by 4.6 mm Hg in the Trabectome cohort (p < 0.001) and by 5.8 mm Hg (p < 0.001) in the goniotomy group at 1-year follow-up. In PEX glaucoma, the mean IOP was reduced by 9.7 mm Hg ( p = 0.002) in the Trabectome surgery and by 6.7 mm Hg(p = 0.004) in the goniotomy cohort 1 year later. Comparing both surgery techniques in POAG, no significant correlation was found in terms of IOP at any of the follow- up visits (IOP at 1 year, p = 0.553). In PEX glaucoma, the IOP, visual acuity, and number of glaucoma medications did not differ significantly between the 2 surgery techniques 1 year later ( IOP: p = 0.300; VA: p = 0.391; therapy: p =0.908). Conclusion: Modified goniotomy and Trabectome surgery are reliable and effective tools for the management of moderate POAG and PEX glaucoma. There was no significant difference in IOP between the 2 procedures over a follow-up period of 1 year.