Combined cataract extraction and trabeculotomy by the internal approach for coexisting cataract and open-angle glaucoma: Initial results

Purpose: To provide an update of the short-term results of combined phacoemulsification and trabeculotomy by the internal approach with a follow-up to 21 months. Setting: Universities and private practices in the United States. Methods: This prospective interventional case series comprised 304 consecutive eyes with open-angle glaucoma and cataract having combined phacoemulsification and trabeculotomy with a Trabectome (NeoMedix Inc.). The Trabectome is designed to open a direct pathway for aqueous to flow from the anterior chamber into Schlemm canal collector channels. Under gonioscopic control, bipolar cautery was applied by a purpose-designed footplate to ablate the trabecular meshwork and inner wall of Schlemm canal. The main outcome measures were intraocular pressure (IOP), glaucoma medication use, and complications. Results: The mean IOP was 20.0 mm Hg ± 6.3 (SD) preoperatively, 14.8 ± 3.5 mm Hg at 6 months, and 15.5 ± 2.9 mm Hg at 1 year. There was a corresponding drop in glaucoma medications from 2.65 ± 1.13 at baseline to 1.76 ± 1.25 at 6 months and 1.44 ± 1.29 at 1 year. Subsequent secondary glaucoma procedures were performed in 9 patients. The only frequent complication, blood reflux in 239 patients (78.4%), resolved within a few days. Conclusions: Combined phacoemulsification and trabeculotomy by the internal approach using the Trabectome lowered IOP and medication use in the majority of patients. Complications were minimal and comparable to those in an earlier series of Trabectome-only procedures.