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. 2017 Sep 14:11:1667-1675.
doi: 10.2147/OPTH.S143061. eCollection 2017.

Comparison of intraocular pressure fluctuations before and after ab interno trabeculectomy in pseudoexfoliation glaucoma patients

Naoki Tojo  1 , Shinya Abe  1 , Mari Miyakoshi  1 , Atsushi Hayashi  1
Affiliations

Comparison of intraocular pressure fluctuations before and after ab interno trabeculectomy in pseudoexfoliation glaucoma patients

Naoki Tojo et al. Clin Ophthalmol. .

Abstract

Purpose: Ab interno trabeculectomy (AIT) with the Trabectome has been shown to reduce intraocular pressure (IOP) in eyes with pseudoexfoliation (PEX) glaucoma. Here, we examined the change of IOP fluctuations before and after only AIT or AIT with cataract surgery in PEX patients using the contact lens sensor Triggerfish®.

Methods: This was a prospective open-label study. Twenty-four consecutive patients with PEX glaucoma were included. Twelve patients underwent cataract surgery and AIT (triple-surgery group), and 12 patients underwent only AIT (single-surgery group). In each eye, IOP fluctuations over 24 h were measured with the contact lens sensor before and at 3 months after the surgery. We compared the change of IOP fluctuation before and after operation. We also evaluated the difference in IOP changes between the triple- and single-surgery groups.

Results: At 3 months after the surgeries, the mean IOP was significantly reduced from 23.5±6.5 mmHg to 14.6±2.8 mmHg in the single-surgery group and from 22.5±3.0 mmHg to 11.5±2.9 mmHg in the triple-surgery group. The mean IOP reduction rate was significantly higher in the triple-surgery group compared to the single-surgery group (p=0.0358). In both groups, the mean range of IOP fluctuations was significantly decreased during nocturnal periods. The mean range of 24 h IOP fluctuations was decreased in the triple-surgery group (p=0.00425), not in the single-surgery group (p=0.970).

Conclusion: Triple surgery could decrease IOP value and the IOP fluctuations to a greater extent than single surgery in PEX glaucoma patients.

Keywords: ab interno trabeculectomy; contact lens sensor; fluctuation; intraocular pressure; pseudoexfoliation.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Example of the results of IOP fluctuation measurement over 24 h periods before and after AIT + PEA + IOL. Notes: (A) Diagram of 24 h continuous IOP fluctuations using the Triggerfish® CLS. The difference between the maximum and minimum values (the arrow) was defined as the range of IOP fluctuations. (B) Zoom mode of IOP fluctuations during diurnal period. (C) Zoom mode of IOP fluctuations during nocturnal period. (D) Gray line: the IOP fluctuation before surgery. Black line: the IOP fluctuation after surgery. Abbreviations: AIT, ab interno trabeculectomy; CLS, contact lens sensor; IOL, intraocular lens; IOP, intraocular pressure; PEA, phacoemulsification.
Figure 2
Figure 2
The average of IOP fluctuation at each 1-hr period before and after AIT (single-surgery group). Notes: Dotted line: before the AIT surgery. Solid line: After AIT surgery. Before AIT, the line of falls rapidly at 5:00 a.m. The IOP fluctuation was smaller before AIT than after AIT during the nocturnal periods. Abbreviations: AIT, ab interno trabeculectomy; IOP, intraocular pressure.
Figure 3
Figure 3
The average of IOP fluctuation at each 1 hr period before and after AIT + PEA + IOL (triple-surgery group). Notes: Dotted line: before the AIT + PEA + IOL. Solid line: After the surgeries. Abbreviations: AIT, ab interno trabeculectomy; IOL, intraocular lens; IOP, intraocular pressure; PEA, phacoemulsification.
Figure 4
Figure 4
The range of IOP fluctuation in single-surgery group. Notes: Boxplots of the range of IOP fluctuation (A) over 24 hr and during the (B) diurnal periods and (C) nocturnal periods before and after AIT. AIT significantly decreased the range of IOP fluctuation during the nocturnal periods (p=0.0425). *p<0.05. Abbreviations: AIT, ab interno trabeculectomy; IOP, intraocular pressure.
Figure 5
Figure 5
The range of IOP fluctuation in Triple-surgery group. Notes: Boxplots of the range of IOP fluctuation (A) over 24-hr and during the (B) diurnal periods and (C) nocturnal periods before and after AIT + PEA + IOL. AIT + PEA + IOL significantly decreased the range of IOP fluctuation throughout the day (p=0.0425) and during the nocturnal periods (p=0.0049). *<0.05; **<0.01. Abbreviations: AIT, ab interno trabeculectomy; IOL, intraocular lens; IOP, intraocular pressure; PEA, phacoemulsification.
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