I am happy to respond to Drs Wei and Razeghinejad regarding our publication. Our data demonstrated that trabeculotomy was significantly more effective for steroid-induced glaucoma than for primary open-angle glaucoma. In the steroid-induced glaucoma group, the surgical success of trabeculotomy was comparable with that of the trabeculectomy group for criterion A (intraocular pressure [IOP] < 21 mm Hg), but was worse than that of trabeculectomy for criterion B (IOP < 18 mm Hg). We did not state that the outcome was better for trabeculotomy than for trabeculectomy in the steroid-induced glaucoma group.

We first would like to address whether combined sinusotomy and trabeculotomy offers greater IOP reduction in glaucoma patients. Mizoguchi and associates reported that combined sinusotomy and trabeculotomy resulted in lower postoperative IOP than trabeculotomy alone. Based on this previous report, many Japanese surgeons perform combined surgery for glaucoma. However, as shown in Table 2 of our report, additional sinusotomy did not affect the surgical success of trabeculotomy significantly in our multicenter study. We therefore propose that additional sinusotomy may make a relatively minor contribution to the surgical success of trabeculotomy for glaucoma.

Second, we would like to point out that 10 of the 121 patients in the trabeculotomy group received intravitreal corticosteroid injections, and that only 1 of these eyes was treated with combined sinusotomy. It therefore is unlikely that the surgical success of trabeculotomy for steroid-induced glaucoma was improved by additional sinusotomy in the eyes that had received intravitreal corticosteroid injections.

Third, we were unable to obtain data on the duration of corticosteroid use before the surgery because of our retrospective study design. Corticosteroid use was stopped fewer than 3 months after the surgery in 53 (43.8%) of the 121 steroid-induced glaucoma patients who underwent trabeculotomy compared with 18 (42.9%) of the 42 steroid-induced glaucoma patients who underwent trabeculectomy, which was not a significant difference.