Ab Interno Trabeculectomy With the Trabectome as a Valuable Therapeutic Option for Failed Filtering Blebs

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Minimally Invasive Procedures

Background:

• Uncontrolled intraocular pressure (IOP) poses a significant challenge post-glaucoma filtration surgery.
• The Trabectome device enables selective electroablation of the trabecular meshwork via a clear cornea incision.
• Minimally invasive glaucoma surgery (MIGS) with the Trabectome has shown promise as a primary surgical option.

Purpose of the Study:

• To evaluate the efficacy of ab interno trabeculectomy using the Trabectome for IOP control in patients with previously failed filtering blebs.
• To assess the Trabectome's safety and effectiveness as a secondary surgical intervention for refractory glaucoma.

Main Methods:

• A single-center observational study included 60 eyes of 60 patients with primary open-angle glaucoma (POAG) or pseudoexfoliative glaucoma (PXG).
• Trabectome surgery was performed either as a standalone procedure or combined with phacoemulsification.
• Intraocular pressure (IOP) and medication usage were recorded by an independent examiner before and after surgery.

Main Results:

• Mean IOP decreased by 36% from 24.5±3.5 mm Hg to 15.7±3.4 mm Hg at a mean follow-up of 415 days.
• The number of IOP-lowering medications reduced by 14%, from 2.1±1.3 to 1.8±1.2.
• Qualified success rates were 87% for PXG and 50% for POAG, with 25% of cases requiring further surgery.

Conclusions:

• Trabectome surgery is a safe and effective 'escape procedure' for managing uncontrolled IOP after failed trabeculectomy, especially in PXG patients.
• While initial medication reduction is observed, IOP may trend towards preoperative levels over time.
• The study highlights the Trabectome's value in a challenging patient subgroup with advanced glaucoma.