Trabectome (trabeculectomy-internal approach): additional experience and extended follow-up

Trans Am Ophthalmol Soc. 2008;106:149-59; discussion 159-60.

Abstract

Purpose: To report a retrospective case series of 1127 Trabectome surgical procedures, including 738 Trabectome-only and 366 Trabectome-phacoemulsification surgeries.

Methods: Electroablation of meshwork via a temporal corneal incision. Outcomes included changes in intraocular pressure (IOP) and medication use, complications, and Kaplan-Meier success estimates.

Results: For all cases, mean preoperative IOP of 23.8 +/- 7.7 mm Hg decreased by 39% to 16.5 +/- 4.0 mm Hg at 24 months (n = 50). Intraoperative reflux bleeding occurred in 77.6%. Medications decreased from 2.8 to 1.2 by 24 months. Sixty-five patients (5.8%) had IOP elevation > 10 mm Hg above baseline on day 1. Failure led to trabeculectomy in 5.9% (n = 67) and shunt installation in 1.6% (n = 18). Kaplan-Meier failure was defined across groups with at least 2 weeks follow-up as IOP > 21 mm Hg with or without medications and not reduced by 20% below baseline on 2 consecutive visits or repeat surgery. For Trabectome-only cases, mean preoperative IOP of 25.7 +/- 7.7 mm Hg was reduced by 40% to 16.6 +/- 4.0 mm Hg at 24 months (n = 46). No prolonged hypotony, choroidal effusion, choroidal hemorrhage, or infections occurred. Failure led to trabeculectomy in 8.1% (n = 60) and shunt installation in 1.9% (n = 14). Medications decreased from 2.93 to 1.2 by 24 months. For Trabectome-phacoemulsification cases, baseline IOP of 20.0 +/- 6.2 mm Hg decreased at 12 months to 15.9 +/- 3.3 mm Hg (18%) (n = 45) and medications decreased from 2.63 +/- 1.12 to 1.50 +/- 1.36. Sixteen (4.4%) of 365 had prior failed trabeculectomy, and 139 of 365 (38%) had prior laser trabeculoplasty.

Conclusion: Trabectome offers a minimally invasive method of improving IOP control in open-angle glaucomas.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents / administration & dosage
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Glaucoma, Open-Angle / physiopathology
  • Glaucoma, Open-Angle / surgery*
  • Humans
  • Infant
  • Infant, Newborn
  • Intraocular Pressure / physiology
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures
  • Phacoemulsification / methods
  • Retrospective Studies
  • Tonometry, Ocular
  • Trabecular Meshwork / physiopathology
  • Trabecular Meshwork / surgery*
  • Trabeculectomy / methods*
  • Young Adult

Substances

  • Antihypertensive Agents