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

Don Minckler, Sameh Mosaed, Laurie Dustin, Brian Francis, 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. FriedmanZ. 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

Research output: Contribution to journalArticle

132 Scopus 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.

Original languageEnglish (US)
Pages (from-to)149-159
Number of pages11
JournalTransactions of the American Ophthalmological Society
Volume106
StatePublished - 2008

ASJC Scopus subject areas

  • Ophthalmology

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    Minckler, D., Mosaed, S., Dustin, L., Francis, B., Apte, D., Bandel, R. E., Shetty, R., Barnett, E. M., Batiste, C., Budenz, D., Chen, T., Rhee, D., Chevrier, R. L., Damji, K., Marshall, D., Compagna, J., Cotter, F., Donas, N., Fellman, R., ... Zacharia, P. T. (2008). Trabectome (trabeculectomy - internal approach): Additional experience and extended follow-up. Transactions of the American Ophthalmological Society, 106, 149-159.