Faculty Collaboration Database

Trabectome (trabeculectomy-internal approach): additional experience and extended follow-up. Trans Am Ophthalmol Soc 2008;106:149-59; discussion 159-60

Date

01/01/2008

Pubmed ID

19277230

Pubmed Central ID

PMC2646453

Scopus ID

2-s2.0-62849090894 (requires institutional sign-in at Scopus site)   168 Citations

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.

Author List

Minckler D, Mosaed S, Dustin L, Ms BF, Trabectome Study Group

Author

Edward M. Barnett MD, PhD Professor in the Ophthalmology and Visual Sciences department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

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