Ab interno trabeculectomy with trabectome: Outcomes in African American versus Caucasian patients

Objective: To compare the intraocular pressure-lowering efficacy and complication rate of ab interno trabeculectomy with the Trabectome between African American (AA) and Caucasian patients with open-angle glaucoma.Methods: A total of 164 patients (82 AA and 82 Caucasian) who underwent ab interno trabeculectomy over an 8-year period were included in this prospective, case-control study. The Neomedix database was used to look for AA or Caucasian patients with open-angle glaucoma who underwent Trabectome with or without phacoemulsification.Results: The average IOP of AA patients was reduced from 21.2 ± 6.8 mm Hg to 16.1 ± 4.1 mm Hg at 12 M (p \u3c 0.01), and the mean number of glaucoma medications was reduced from 2.4 ± 1.3 to 2.0 ± 1.4 (p = 0.13). Among Caucasians, the mean IOP was reduced from 21.2 ± 6.8 mm Hg to 15.7 ± 4.2 mm Hg at 12 M (p \u3c 0.01), and the number of medications dropped from 2.4 ± 1.2 to 1.7 ± 1.3 (p \u3c 0.01). No statistically significant difference was found between these 2 race groups in IOP, number of medications, and complications. For complications with Trabectome alone, 13% of AA and 9% of Caucasian patients needed secondary surgery. There was only 1 case of hypotony which was in the AA group. For complications with Trabectome combined with phacoemulsification, 4% of AA as well as 4% of Caucasian patients required secondary surgery. There was only 1 case of hypotony which was in the Caucasian group.Conclusion: Ab interno trabeculectomy with Trabectome is associated with a reduction in IOP in both race groups with a similar complication and survival profiles

Tube shunt surgery in pig eyes: A wet lab teaching model

Objective: To describe a teaching model for aqueous tube shunt surgery using freshly enucleated pig eyes.Design: A descriptive methods report, containing a small prospective noncomparative interventional case series.Participants: Six ophthalmology residents from the University of Alberta program.Methods: A descriptive report outlines the materials and methods required for creating a surgical wet lab that teaches aqueous draining device implantation. Residents practiced each step associated with the insertion of plated aqueous tube shunt devices in porcine eyes.Results: The porcine model worked well to demonstrate and perform steps associated with tube implant surgery. Trainee comfort improved in all surgical steps practiced during the session when reassessed at 3-month follow-up: priming and anchoring the drainage device (p = 0.042), inserting the tube into the eye (p = 0.025), creating and securing a scleral patch graft (p = 0.034), and closure of the conjunctiva (p = 0.034). Overall confidence in performing tube shunt surgery also remained above baseline at follow-up (p = 0.042).Conclusions: Implantation of tube shunt devices in the porcine model closely resembles surgery in human eyes. Practicing each step associated with tube shunt surgery on porcine eyes in a supervised wet-lab environment improves trainee confidence in the procedure