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. 2008:106:149-59; discussion 159-60.

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

Don Minckler  1 , Sameh Mosaed, Laurie Dustin, Brian Francis Ms; Trabectome Study Group
Collaborators, Affiliations

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

Don Minckler et al. Trans Am Ophthalmol Soc. 2008.

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.

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Figures

FIGURE 1
FIGURE 1
Changes in intraocular pressure (IOP) in Trabectome-only cases (N = 738)
FIGURE 2
FIGURE 2
Changes in adjunctive medication use in Trabectome-only cases (N = 738).
FIGURE 3
FIGURE 3
Kaplan-Meier plot of probability of success, according to failure definition 1, in all cases (N = 1127).
FIGURE 4
FIGURE 4
Kaplan-Meier plot of probability of success, according to failure definition 1, in Trabectome-only cases (N = 738).
FIGURE 5
FIGURE 5
Kaplan-Meier plot of probability of success, according to failure definition 1, in combined Trabectome and phacoemulsification (N = 366).
FIGURE 6
FIGURE 6
Changes in intraocular pressure (IOP) in Trabectome-phacoemulsification cases (N = 366).
FIGURE 7
FIGURE 7
Changes in adjunctive medication use in Trabectome-phacoemulsification cases (N = 366).
FIGURE 8
FIGURE 8
Kaplan-Meier plot of probability of success, according to failure definition 2, in all cases (N = 1127).
See this image and copyright information in PMC

References

    1. Gedde SJ, Schiffman JC, Feuer WJ, Herndon LW, Brandt JD, Budenz DL. Treatment outcomes in the Tube versus Trabeculectomy Study after one year of follow-up. Am J Ophthalmol. 2007;143:9–22. - PubMed
    1. Gedde SJ, Herndon LW, Brandt JD, Budenz DL, Feuer WJ, Schiffman JC. Surgical complications in the Tube versus Trabeculectomy Study during the first year of follow-up. Am J Ophthalmol. 2007;143:23–31. - PubMed
    1. Minckler DS, Baerveldt G, Alfaro MR, Francis BA. Clinical results with the TrabectomeTM for treatment of open-angle glaucoma. Ophthalmology. 2005;112:962–967. - PubMed
    1. Francis BA, See RF, Rao NA, Minckler DS, Baerveldt G. Ab interno trabeculectomy: development of a novel device (TrabectomeTM) and surgery for open-angle glaucoma. J Glaucoma. 2006;15:68–73. - PubMed
    1. Minckler DS, Baerveldt G, Ramirez MA, et al. Clinical results with the Trabectome, a novel surgical device for treatment of open-angle glaucoma. Trans Am Ophthalmol Soc. 2006;104:40–50. - PMC - PubMed

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