1. Japanese Red Cross Society
Trabectome outcomes in Asians with Primary open-Angle Glaucoma With or Without Cataract
Gifu Red Cross Hospital
Department of ophthalmology
Masahiro Maeda M.D.

2. I have no financial interest
Japanese Red Cross Society
I have no financial interest

3. Purpose of this study Main outcomes
Japanese Red Cross Society
Purpose of this study
To evaluate the Outcomes of the Trabectome® for Asian Glaucoma Patients with or without Cataract
Main outcomes
Intraocular pressure
Medication usage before and after surgery
Complications
Corneal endothelial cell density

4. Japanese Red Cross Society
Surgical system
The Trabectome system consists of a disposable handpiece with irrigation and aspiration functions as well as an electrocautery unit at its tip.

5. Method 1.7mm temporal clear corneal incision
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Method 1 2 3 4 5
1.7mm temporal clear corneal incision
Inflate anterior chamber with viscoelastic
Insert tip into Schlemm’s canal
Ablate nasal trabecular meshwork
Reverse ablation
In combined case, Cataract extraction and IOL implantation
Remove viscoelastic

6. Demographics Japanese Red Cross Society Trabectome only
Trabectome + Phaco
Number
149
121
Age
Mean 61 71
STD 20 10
Minimum 32
Maximum 90
Gender
Males 88 60
Females 58
Not Indicated 3
Diagnosis
POAG 81 89
Pseudoexfoliation (PEX) 15 7
JRA
COAG 2
Myopic degeneration
Steroid Induced 4 1
Pigment Dispersion
Uvetic
Other or not indicated 44 23
Pre-Op Snellen Acuity
20/20 – 20/40
20/50 – 20/70
20/80 – 20/100 9
20/ /400 6
<20/400 NR 98 69
VF Status
Minimal
Moderate 35 43
Advanced 50
MD/Other
Disc C/D (if known)
<0.7 28 33
0.7 through 0.8 84 54
>0.8 29 25 8
Lens Status
Psuedophakic 73
Phakic 66
120
Aphakic 1
Not Indicated 9
Shaffer Grade I II 4 20
III 55 52 IV 79 42 10 6
Ptyerigium
Pediatric (Age 0-21 years)
Prior Surgeries
SLT 16 11
ALT 7 3
Shunt
Trabeculectomy
Trabectome
Vitrectomy LI
ECP
Yag
Retina Surgery
CRVO
Combined Surgeries
Trabectome + Phaco
121
Trabectome + Goniosynechia
Trabectome + shunt
Trabectome + Penetrating Keratoplasty
Trabectome + ECP
Trabectome + Bleb Revision
Trabectome ONLY
149

7. IOP and Rx COMPLETE DATABASE - ASIANS - TRABECTOME ONLY
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COMPLETE DATABASE - ASIANS - TRABECTOME ONLY
IOP (mmHg)
% Reduction
2nd Surgery RX
Avg.
STD
No.
Cumulative #
Post-Pre
Pre-op IOP
26.0
7.7 0%
149
3.34
1.22
1 day
20.5
10.3
-18%
148
3.23
1.39
-3%
3 day
19.3
7.4
-22%
146
1.41
-4%
1 Week
18.7
7.2
-24%
3.42
1.38 2%
2 Weeks
17.8
6.2
-27%
144
3.47
1.31 4%
1 month
17.3
5.3
-29%
141
3.31
1.32
-1%
2 months
17.4
4.8
-28%
130 3
3.21
1.29
3 months
17.7
5.0
118 5
2.97
1.13
-11%
4 months
4.6
105 8
2.77
1.15
-17%
5 months
17.5
4.7 97 12
2.71
1.18
-19%
6 months
4.3 91
7 months
4.0 78 14
2.63
1.26
-21%
8 months
-31% 69 15
2.54
9 months
3.8
-30% 64
2.52
-25%
10 months
17.9
4.4 61
2.59
1.28
-23%
11 months
4.2 54
2.67
-20%
12 months
18.0
4.5 48 17
2.56
1.35
15 months 39 18
2.44
1.33
18 months
4.9 25
2.48
-26%
21 months 19 20
2.95
-12%
24 months
16.8
-35% 11 21
2.73
1.42
30 months
13.8
2.6
3.00
0.71
-10%
36 months
16.0
-33% 1
40 months
14.0
-42%
44 months
12.5
-48%
4.00
20%
Total Mean
17.2
5.1
2.9
1.3
-14%

8. IOP and Rx COMPLETE DATABASE - ASIANS - TRABECTOME + Phaco
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COMPLETE DATABASE - ASIANS - TRABECTOME + Phaco
IOP (mmHg)
% Reduction
2nd Surgery RX
Avg.
STD
No.
Cumulative #
Post-Pre
Pre-op IOP
21.2
7.3 0%
121
1.12
1 day
19.2
9.4
-4%
118
2.71
1.33 8%
3 day
17.8
6.4
-9%
115
2.78
1.30
11%
1 Week
16.7
6.3
-14%
2.89
15%
2 Weeks
15.6
5.6
-22%
113
2.92
1.25
17%
1 month
14.9
4.6
-25%
109
2.82
1.19
12%
2 months
4.1
-24%
106
2.46
1.20
-2%
3 months
14.8
3.8
104
2.22
-11%
4 months
3.5 97
2.03
1.21
-19%
5 months
3.4
-21% 90
1.96
1.15
6 months
15.0 82
1.87
1.17
7 months
3.6
-18% 79
1.80
1.18
-28%
8 months 76
1.82
1.22
-27%
9 months
15.3
3.2 71
1.16
10 months
15.5 68
1.79
1.24
11 months
15.9
3.3
-16% 62 1
12 months
16.6
-15% 56
1.89
1.29
15 months
16.3
4.2 50
1.98
1.32
18 months
16.5
-17% 29
2.31
1.37
-8%
21 months 23
2.09
24 months
2.5 8
2.38
0.92
-5%
30 months
15.4
3.7 7
1.11
36 months
17.0
4.8 4
2.00
1.41
-20%
40 months
2.8
-12% 3
1.67
0.58
-33%
44 months
14.0
-30%
Total Mean
15.8
2.2
1.2

9. Trabectome only Trabectome + Phaco
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Trabectome only
Trabectome + Phaco

10. Corneal endothelial cell density
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Corneal endothelial cell density
statistically NO significant difference: Paired t test
Trabectome only (pre: 2406(n=77), 6M: 2334(n=44))
Trabectome+Phaco (pre: 2598(n=76), 6M: 2568(n=44))

11. Complications No serious vision threatening complication
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Trabectome only
Trabectome + Phaco
Total number of Patients
149
121
Trabeculectomy post Trabectome 12
Shunt post Trabectome 4
Diode Cyclo Photo Coagulation 1
SLT post Trabectome
Phaco post Trabectome
ECP post Trabectome
Trabectome post Trabectome (patient request)
Tube Ligature Release on combined Tube and Trabectome
Total Secondary Surgery 21
Eyes out of Study due to patient move - no follow up record 3
Eyes out of study due to patients death (not related to Trabectome procedure) 2
Sustained Hypotony (IOP < 5 mmHg) one month post op
Hypotony (IOP < 5 mmHg) one day post op
IOP-1D > 10 mmHg from pre op IOP 15 14
Aqueous Misdirection
Infection
Bleb Formation
Wound Leaks
Problematic Pain
Choroidal Effusion
Choroidal Hemorrhage
Visual Acuity Decrease (> 2 lines)
Combination Phaco+Trabectome
Combination Shunt+Trabectome
Pediatric (Infantile and Juvenile Age range 0 to 21 years) 9
Intra Operative Blood Reflux:
Yes
120
118 No
not reported 20
No serious vision threatening complication

12. Conclusion Acknowledgement
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Conclusion
Trabectome, Ab interno trabeculotomy, is ・・・
effective without any serious complications.
safe procedure for Asian glaucoma patients to reduce IOP.
But, of course,
do not expect extremely low IOP
Acknowledgement
Trabectome Study Group