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Background: Trabeculotomy with the Kahook knife is a new ab interno minimally invasive glaucoma surgery (MIGS) procedure. The MIGS are usually performed in early to intermediate glaucoma eyes. In this retrospective study we analyzed the intraocular pressure (IOP) and topical glaucoma eye drop therapy (Meds) reduction achieved by the Kahook trabeculotomy (TO) without (n = 19) or with (n = 18) combined cataract operation (Cat-TO) as initial treatment before or to avoid filtering surgery., Material and Methods: A total of 37 eyes of 37 patients were examined when IOP was > 21 mm Hg in at least 2 examinations despite the maximum tolerable Meds applied. Cat-TO was performed in 18 phakic eyes (primary open-angle glaucoma, POAG = 11, pseudoexfoliation glaucoma, PEX = 5, ocular hypertension, OHT = 2). In 19 pseudophakic eyes (POAG = 12, PEX = 6, OHT = 1) an isolated TO was executed. Complete success (no Meds) and relative success (irrespective of Meds) for IOP ≤ 21 mm Hg, ≤ 18 mm Hg, ≤ 16 mm Hg were evaluated 2, 6 and 12 months postoperatively., Results: The IOP was significantly reduced from preoperatively to 2 months after Cat-TO as well as after TO (Cat-TO: 26.8 ± 5.9 mm Hg to 16.0 ± 2.9 mm Hg, p < 0.001; TO: IOD 28.2 ± 5.6 mm Hg to 16.3 ± 3.5 mm Hg, p < 0.001). Meds reduction after Cat-TO as well as after TO was not significant (Cat-TO: 2.1 ± 1.3 to 1.3 ± 1.3, p = 0.11; TO: Meds 2.7 ± 1.1 to 2.2 ± 1.3, p = 0.23); however, Meds reduction after 6 and 12 months was significantly greater in the Cat-TO group compared to the TO group (p = 0.02). The IOP and Meds did not change significantly from 2 to 6 months. After Cat-TO, qualified success after 12 months for IOP ≤ 18 mm Hg was 61% (11/18) and for IOP ≤ 16 mm Hg 28% (5/18). After TO, qualified success after 12 months for TO was 47% (9/19) for IOP ≤ 18 mm Hg and 26% (5/19) for IOP ≤ 16 mm Hg. The intervention was not sufficient for 7 patients after TO and 2 patients after Cat-TO (IOP two times > 21 mm Hg)., Conclusion: The first year results show that TO as well as Cat-TO are effective minimally invasive interventions to delay or even avoid a filtrating operation. In case of Meds intolerance and target IOP ≤ 16 mm Hg Cat-TO is not sufficient., (© 2023. The Author(s).)

Purpose: To evaluate the efficacy and safety of excisional goniotomy performed with the Kahook Dual Blade (KDB) combined with cataract surgery in patients with pimary open angle glaucoma (POAG) and Normal Tension Glaucoma (NTG) under topical therapy. Further sub-analysis was performed to compare between 90 and 120 degrees goniotomy., Methods: This was a prospective case series of 69 eyes from 69 adults (age 78 ± 5.9 years; male = 27, female = 42). Indications for surgery included insufficient IOP control with topical medication, glaucomatous damage progression under topical therapy and reduction of medication burden. Complete success was defined as IOP lowering below 21 mmHg without the need for topical medication. For NTG patients, complete success was defined as IOP lowering below 17 mmHg without the need for topical medication., Results: IOP was significantly lowered from 19.7 ± 4.7 to 15.1 ± 2.7 at 2 months, 15.8 ± 2.3 at 6 months and 16.1 ± 3.2 at 12 months (p < 0.05) for POAG and 15.1 ± 2.5 to 14.1 ± 2.4 at 2 months, 14.1 ± 3.1 at 6 months and 13.6 ± 1.8 at 12 months (p > 0.08) for NTG, respectively. Complete success was achieved in 64% of the patients. IOP lowering under 17 mmHg without the need for topical medication was achieved in 60% of the patients at 12 months. In NTG patients (14 eyes) IOP lowering under 17 mmHg without the need for topical medication was achieved in 71%. No significant difference was recorded in terms of IOP lowering at 12 months in-between 90° and 120° of treated trabecular meshwork (p > 0.7). No severe adverse reactions were recorded in this study., Conclusion: One-year results show that KDB combined with cataract surgery is an effective treatment option for glaucoma patients. IOP lowering was successfully achieved in NTG patients with complete success in 70% of the patients. In our study, no significant differences were recorded in-between 90° and 120° of treated trabecular meshwork., (© 2023. The Author(s).)

Purpose: Single-use dual blade goniotomy (SBG) is a novel ab interno procedure that removes three to five clock hours of trabecular meshwork (TM). We analysed the reduction of intraocular pressure (IOP) and topical glaucoma medication (Meds) in eyes following combined cataract surgery and SBG (Cat-SBG)., Methods: IOP and Meds were evaluated retrospectively in 55 eyes of 38 patients. 44 eyes had high tension glaucoma (HTG) and eleven eyes had normal tension glaucoma (NTG). Complete success (no Meds) and qualified success (with Meds) for IOP levels ≤ 21, ≤ 18 , ≤ 16 mmHg or ≥ 20% IOP reduction at the two- and six-month follow-up were evaluated., Results: IOP and Meds were significantly reduced from before to two months after Cat-SBG in HTG- and NTG-patients (HTG: IOP 19.4 ± 3.3 to 15.1 ± 3.3 mmHg; p < 0.001; Meds 2.1 ± 1.3 to 0.8 ± 1.3; p < 0.001; NTG: IOP 14.0 ± 2.3 to 11.5 ± 2.3 mmHg; p = 0.004; Meds 1.6 ± 0.7 to 0.3 ± 0.7; p < 0.001). IOP and Meds did not change significantly from two to six months after Cat-SBG. In HTG, complete and qualified success rates were 43% (19/44) and 93% (41/44) for IOP ≤ 18 mmHg, 36% (16/44) and 64% (28/44) for IOP ≤ 16 mmHg and 30% (13/44) and 43% (19/44) for ≥ 20% IOP reduction six months after surgery. In NTG, complete and qualified success was 81% (9/11) and 100% (11/11) for IOP ≤ 18 and ≤ 16 mmHg, and 27% (3/11) for IOP reduction ≥ 20%. IOP and Meds reduction were comparable between HTG and NTG eyes. Only minor postoperative complications occurred., Conclusion: Cat-SBG is an efficient method to significantly lower IOP in patients with HTG and NTG., (© 2022. The Author(s).)

Background: Trabeculectomy (TE) with the use of antimetabolites is the standard procedure in glaucoma surgery, whereas canaloplasty (CP) is a nonpenetrating and potentially less invasive alternative., Objective: The aim of this retrospective case series was to compare the long-term success of CP and TE under the same conditions and with the same levels of experience of the surgeon as well as to investigate whether preoperative intraocular pressure (IOP) and postoperative IOP correlate with eachother., Methods: The study included 57 eyes that underwent either CP or TE (CP n = 27; male = 50.0% age 60.7 ± 13.2 years; TE n = 30; male = 55.6% age 68.0 ± 9.1 years). Each of the procedures was performed by the same surgeon with comparable levels of experience. The comparison included preoperative and postoperative visual field damage, preoperative and postoperative IOP (mm Hg) after 1 and 6 weeks, 6 and 12 months as well as in the long-term course (1-3 years) and the necessary local treatment at the corresponding times., Results: With both methods no worsening of the visual field could be detected and the patient groups showed comparable preoperative and postoperative mean deviations (MD). The CP showed a positive correlation between preoperative and postoperative 1‑year IOP (r = 0.4; p = 0.022), whereas TE showed no significant correlation between preoperative and postoperative IOP. The count of local antiglaucoma medication in long-term comparison (1-3 years after surgery) was higher after CP than after TE (1.5 ± 1.6 vs. 0.5 ± 0.8; p = 0.003). In both groups there were no severe postoperative complications. The overall success rates (without treatment) were higher at all time points after TE., Discussion: With both methods conducted by the same surgeon with the same levels of experience, an effective reduction of the IOP was achieved. It seems that the higher the preoperative IOP before CP, the higher the achievable pressure after 1 year and in the long term. In contrast, after TE the IOP was effectively reduced in the long term regardless of the initial IOP. The CP seems to be inferior to TE under the same conditions with respect to complete surgical success (without local treatment).

Background: Canaloplasty is a well-established non-penetrating glaucoma surgery. Unsuccessful outcomes can be enhanced by micro-invasive 360° suture trabeculotomy (360°trabeculotomy), analyzed in this study., Methods: This retrospective study included twenty eyes of 19 patients, mean age 59.7±17.2 years, with primary open-angle glaucoma (POWG n = 14), pseudoexfoliation glaucoma (PEX n = 3), juvenile glaucoma (n = 2) and aphakic glaucoma (n = 1), who underwent micro-invasive 360° trabeculotomy after unsuccessful (intraocular pressure (IOP) >21 mmHg under maximum glaucoma eye drop therapy (Meds)) canaloplasty. IOPs, Meds, complications and failure rates (IOP >21 mmHg at two consecutive follow-ups) were evaluated. Complete success (no Meds) and qualified success (with Meds) rates for IOP levels ≤21 mmHg and ≤ 18 mmHg at the last follow-up were evaluated., Results: IOPs and Meds were significantly reduced from before to 1 week (10.3±3.1 days) after 360° trabeculotomy (IOP, 28.3±6.0 mmHg to 15.8±4.5 mmHg; p < 0.001; Meds, 3.1 ± 1.2 to 1.0 ± 1.2; p < 0.001). IOPs (p = 0.37) and Meds (p = 0.33) did not decrease further from 1 week until the last follow-up (18.3 ± 8.2 months (IOP, 14.4±3.8 mmHg; Meds, 1.5±1.3)). Complete and qualified success was 25% (5/20) and 70% (14/20) for IOP ≤21 mmHg, as well as 25% (5/20) and 60% (12/20) for IOP ≤18 mmHg. Four eyes had postoperative hyphema, which resolved after a mean period of 4.0 ± 2.2 days. Five failures occurred after a mean of 40.6 ± 51.9 days after 360° trabeculotomy. All failures underwent trabeculectomy. Eyes that needed early (≤3 months post canaloplasty) 360° trabeculotomy showed higher IOPs before (p < 0.001) and lower (p = 0.03) IOPs 2 months post 360° trabeculotomy than eyes with late (>3 months) 360° trabeculotomy surgery., Conclusions: 360° trabeculotomy is a safe, micro-invasive, simple and successful method to enhance failed canaloplasty.

Purpose: To evaluate the long-term outcome of trabeculectomy with intra- and postoperative 5-fluorouracil (5-FU) application in glaucoma., Methods: Eighty-six patients with glaucoma planned for primary trabeculectomy with 5-FU and a minimum follow-up of 3 years were retrospectively analyzed. Success rates, postsurgical 5-FU injections, needling procedures, and complications were analyzed., Results: Mean intraocular pressure (IOP) decreased from 27.2 ± 6.7 to 13.2 ± 4.2 mm Hg at 1 year and 13.8 ± 3.7 mm Hg at the 3-year follow-up. The complete success rates (no IOP-lowering medication) were 83, 79, 73, and 45% at 1 year for IOP ≤21, ≤18, ≤16, and ≤12 mm Hg, respectively, and 64, 59, 56, and 20% for these criteria at 3 years. The average number of medications decreased from preoperatively 2.9 ± 1.4 to 0.2 ± 0.5 at 1 year and 0.7 ± 1.1 at 3 years. During the first 6 months, subconjunctival 5-FU injections were performed in 49 cases. Eleven patients underwent bleb needling during the first 6 months and 13 patients underwent the procedure between the 6th month and the 3rd year. Malignant glaucoma and bleb-related endophthalmitis occurred in 1 patient each., Conclusions: Trabeculectomy with 5-FU is an efficient surgical procedure for glaucoma treatment when combined with intensified postsurgical care., (© 2017 S. Karger AG, Basel.)

Purpose: Intensive postoperative care is essential for the outcome of trabeculectomy. However, in a rural setting, repeated visits to the operating theatre are often not requested or possible. The objective of this study was to examine the outcome of trabeculotomy combined with cataract surgery in patients with glaucoma. Patients and Methods: 142 patients with glaucoma and cataract were included in a retrospective clinical study. All patients were operated on from November 2005 to December 2008 by a single surgeon and with a minimum follow-up of 2 months. Intraocular pressure (IOP), number of antiglaucomatous medications and surgical success rate were assessed at 2 months and at the longest follow-up (at least 1 year). Results: IOP was significantly reduced from 24.1 ± 8.3 mmHg preoperatively to 14.9 ± 3.3 mmHg at 2 months (p < 0.0001) and to 15.1 ± 3 mmHg at the longest follow-up (3.71 ± 1.5 years). The number of IOP-lowering medications was lowered from 1.35 ± 1 preoperatively to 0.73 ± 1 at the longest follow-up. Complete surgical success (no IOP-lowering medications, longest follow-up) was achieved in 51.3 % (IOP < 22 mmHg) and 47.5 % (IOP < 19 mmHg) of patients, respectively. Conclusions: Trabeculotomy combined with cataract surgery is a safe and effective surgical option to treat combined cataract and glaucoma without the need of intensified postoperative treatment., (Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: Previous reports showed increased flow velocities in retrobulbar vessels after glaucoma surgery in the first weeks. Colour Doppler imaging was performed to investigate the long-term effects of trabeculectomy on retrobulbar haemodynamics in patients with primary open-angle glaucoma (POAG)., Methods: In a prospective study 30 patients (mean age 63.2 ± 15.4 years) with POAG were included. Colour Doppler imaging was performed before 1-2 weeks, after 2 months, after 4-6 months, and up to 3 years after trabeculectomy to determine the peak systolic and end-diastolic velocities in the ophthalmic artery, central retinal artery, and the short nasal and temporal posterior ciliary arteries., Results: Mean follow-up was 416 ± 246 days. In the first postsurgical period mean intraocular pressure (IOP) decreased after trabeculectomy from 25 ± 6 mmHg to 9 ± 4 mm Hg (p < 0.0001) and then increased in the further follow-up to 13 ± 3 mmHg (p < 0.05) without any anti-glaucomatous medication. Colour Doppler imaging revealed a significant increase of the end-diastolic velocities of the central retinal artery at all postoperative visits compared to pre-surgery (p < 0.003) and of the end-diastolic velocities in the temporal posterior ciliary arteries (p < 0.003). The change of blood flow parameters that increased during follow-up was significantly correlated to the change in ocular perfusion pressure and IOP., Conclusions: End-diastolic velocities of the central retinal artery and of the temporal posterior ciliary arteries increased after successful trabeculectomy and remained stable in a longer period - even if IOP rose significantly in the follow-up., (© 2014 The Authors Ophthalmic & Physiological Optics © 2014 The College of Optometrists.)

Purpose: Trabeculectomy is among the first choice surgical treatments for glaucoma. Antimetabolites, especially mitomycin C, have improved the success rate. The aim of this study is to present the results of trabeculectomy with 5-fluorouracil (5-FU)., Methods: A total of 71 consecutive trabeculectomies with 5-FU for decompensated glaucoma with at least 1 year follow-up data were retrospectively evaluated. The absolute (without therapy) and relative (with therapy) success rates for glaucoma medication were determined for intraocular pressure (IOP) levels of ≤ 21 mmHg, ≤ 18 mmHg, ≤ 15 mmHg and ≤ 12 mmHg respectively. Postoperative 5-FU administration rates, needling procedures and complications were recorded., Results: Sufficient follow-up data were available for a total of 55 patients. The average IOP was preoperatively 29.6 ± 7.3 mmHg (3 ± 1.4 active ingredients, partly acetazolamide), after 6 months 13.2 ± 4.1 mmHg and after 1 year 13.7 ± 4.3 mmHg. Complete success at 6 months postoperatively for the given pressure levels: were 92 %, 87 %, 79 % and 52% and at 1 year 87 %, 84 %, 51 % and 56%, respectively. Postoperative relative success for these pressure levels at 6 months were 96 %, 90 %, 81 % and 54% and at 1 year 96 %, 93 %, 58 % and 58%, respectively. Administrations of 5-FU postoperatively were no intervention (n=30 patients), subconjunctival 5-FU administration (n=25) and needling procedures (n=6). A temporary hypotension with a shallow anterior chamber was seen in 6 patients, cataract development in 5 patients and 1 patient developed corneal decompensation (multiple previous operations before trabeculectomy)., Conclusion: Trabeculectomy with intraoperative 5-FU administration showed very high success rates after 1 year. Serious complications were rarely seen. Intraoperative 5-FU administration can be considered as an alternative treatment to trabeculectomy with intraoperative use of mitomycin C.