Illuminated microcatheter-facilitated 360-degree trabeculotomy for refractory aphakic and juvenile open-angle glaucoma.

Background: Aphakic and juvenile open-angle glaucoma (JOAG) cases often prove to be challenging to manage, frequently requiring surgical intervention. Angle surgery has some reported success in these cases.

Objective: The purpose of this study was to evaluate 360-degree trabeculotomy, facilitated by iTrack, for refractory aphakic glaucoma and JOAG.

Methods: This study was conducted to evaluate the success and complication rates of illuminated microcatheter-assisted 360-degree trabeculotomy for aphakic glaucoma and JOAG (2 surgeons/2 sites, 2008 to 2011). The success of this surgery was defined as intraocular pressure ≤22 mm Hg with >30% reduction, without disease progression, oral glaucoma medications, or additional glaucoma surgery. One eye per subject was analyzed. All had gonioscopically open angles preoperatively.

Results: A total of 23 eyes status post iTrack-facilitated 360-degree trabeculotomy, 13 aphakic glaucoma cases (mean age 3.1 y at surgery), and 10 JOAG cases (mean age, 18.6 y) were included in the study. Complete cannulation/opening of the Schlemm canal occurred intraoperatively in 8 aphakic and in all JOAG cases. Success rates achieved at last follow-up were as follows: 8/13 (62%) aphakic glaucoma cases and 9/10 (90%) JOAG cases. Preoperative versus final intraocular pressure decreased for all surgically successful eyes (35.5±3.9 vs. 17.3±4.6 mm Hg for aphakic glaucoma, P<0.0001, after mean 30 mo and 30.7±7.4 vs. 13.4±2.8 mm Hg for JOAG, P=0.0001, after mean 10 mo). All trabeculotomy failures (n=5) occurred within 5 months. Complications included vitreous hemorrhage (2 aphakic eyes) and transient choroidal effusion (1 aphakic eye).

Conclusions: iTrack-facilitated 360-degree trabeculotomy shows early promise for initial surgical treatment of medically refractory aphakic glaucoma and JOAG, with few complications and without affecting future surgical options.