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

Don Minckler, Sameh Mosaed, Laurie Dustin, Brian Francis Ms, Trabectome Study Group, D Apte, R E Bandel, R Shetty, E M Barnett, C Batiste, D Budenz, T Chen, D Rhee, R L Chevrier, K Damji, D Marshall, J Compagna, F Cotter, N Donas, R Fellman, D Friedman, Z Ghiasi, C Girkin, D Godfrey, A Jamil, M Johnstone, R Mills, L S Jones, Y H Kwon, D Laroche, M Leen, M Maeda, B B Mahan, K Mitchell, Q Nguyen, G Osmundson, C Patitsas, M Ramirez, G Reiss, R Rosenquist, J Schuman, P Sidoti, C J Siegfried, A Sit, M Stiles, R Tamesis, T Tanji, J Trible, S D Vold, M Watanabe, R Weinreb, P T Zacharia, Don Minckler, Sameh Mosaed, Laurie Dustin, Brian Francis Ms, Trabectome Study Group, D Apte, R E Bandel, R Shetty, E M Barnett, C Batiste, D Budenz, T Chen, D Rhee, R L Chevrier, K Damji, D Marshall, J Compagna, F Cotter, N Donas, R Fellman, D Friedman, Z Ghiasi, C Girkin, D Godfrey, A Jamil, M Johnstone, R Mills, L S Jones, Y H Kwon, D Laroche, M Leen, M Maeda, B B Mahan, K Mitchell, Q Nguyen, G Osmundson, C Patitsas, M Ramirez, G Reiss, R Rosenquist, J Schuman, P Sidoti, C J Siegfried, A Sit, M Stiles, R Tamesis, T Tanji, J Trible, S D Vold, M Watanabe, R Weinreb, P T Zacharia

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.