Outcomes of ab interno trabeculectomy with the trabectome after failed trabeculectomy.

Abstract

AIM:

To evaluate outcomes of ab interno trabeculectomy (AIT) with the trabectome following failed trabeculectomy.

METHODS:

Prospective study of AITs and phaco-AITs after a failed trabeculectomy. The indication for AIT was intraocular pressure (IOP) above target on maximally tolerated therapy, and for phaco-AIT a visually significant cataract and need to lower IOP or glaucoma medications. Outcomes included IOP, medications, complications, secondary procedures and success, defined as IOP of less than 21 mm Hg and a greater than 20% reduction from baseline without further surgery. Exclusion criteria were trabeculectomy less than 3 months prior to AIT or follow-up under 1 year.

RESULTS:

Seventy-three eyes of 73 patients with 1 year follow-up were identified. At 1 year, mean IOP in AIT significantly decreased by 28% from 23.7±5.5 mm Hg, and medications from 2.8±1.2 to 2±1.3 (n=58). In phaco-AIT, the mean IOP decreased 19% from 20±5.9 mm Hg and medications from 2.5±1.5 to 1.6±1.4 (n=15). Transient hypotony occurred in 7%, and further surgery was necessary in 18%. For AIT and phaco-AIT, the 1-year cumulative probability of success was 81% and 87%, respectively.

CONCLUSIONS:

Both AIT and phaco-AIT showed a reduction in IOP and medication use after 1 year, suggesting that AIT with or without cataract surgery is a safe and effective option following failed trabeculectomy.

• Authors: I I Bussel, K Kaplowitz, J S Schuman, N A Loewen, Trabectome Study Group
• Journal: The British journal of ophthalmology (Br J Ophthalmol) Vol. 99 Issue 2 Pg. 258-62 (Feb 2015) ISSN: 1468-2079 [Electronic] England
• PMID: 25170064 (Publication Type: Comparative Study, Journal Article)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Female
• Glaucoma (physiopathology, surgery)
• Humans
• Intraocular Pressure (physiology)
• Male
• Middle Aged
• Phacoemulsification
• Reoperation
• Tonometry, Ocular
• Trabecular Meshwork (surgery)
• Trabeculectomy (methods)
• Treatment Failure
• Treatment Outcome
• Young Adult