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Effect of a failed trabectome on subsequent trabeculectomy.

Seung Youn Jea¹, Sameh Mosaed, Steven D Vold

¹Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA.

Journal of Glaucoma

|February 22, 2011

Summary

A prior failed trabectome procedure does not negatively impact the success of a subsequent trabeculectomy surgery for glaucoma. Glaucoma patients can expect similar outcomes and complication rates regardless of previous trabectome failure.

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Area of Science:

Ophthalmology
Glaucoma Surgery
Surgical Outcomes

Background:

Trabectome surgery is a common procedure for open-angle glaucoma.
Failure of trabectome surgery may necessitate further intervention.
The impact of prior trabectome failure on subsequent glaucoma surgery outcomes is not well-established.

Purpose of the Study:

To evaluate the efficacy and safety of trabeculectomy following a failed trabectome procedure.
To compare the outcomes of trabeculectomy in patients with and without a history of failed trabectome.

Main Methods:

A cohort study compared eyes undergoing trabeculectomy after a failed trabectome (study group) to those undergoing initial trabeculectomy (control group).
Inclusion criteria included open-angle glaucoma, age ≥18, and uncontrolled intraocular pressure (IOP) despite maximal medical therapy.

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Outcome measures included IOP, success rate, and complications, with failure defined by need for further surgery or persistent elevated IOP.

Main Results:

Mean follow-up was 15.4 months (study) and 18.6 months (control).
Both groups achieved significant IOP reduction, with 2-year success rates of 60.2% (study) and 55.5% (control) (P=0.895).
Failed trabectome was not associated with trabeculectomy failure, and postoperative complications were similar between groups.

Conclusions:

A prior failed trabectome procedure does not adversely affect the success rate of a subsequent trabeculectomy.
Trabeculectomy remains a viable surgical option for glaucoma patients even after trabectome failure.
Systemic hypertension and preoperative medication count were identified as risk factors for trabeculectomy failure.