COMMENTARY

Is Trabectome Effective After Failed Tube-Shunt Surgery?

Shuchi B. Patel, MD

Disclosures

November 18, 2015

Results of Trabectome Surgery Following Failed Glaucoma Tube Shunt Implantation: Cohort Study

Mosaed S, Chak G, Haider A, Lin KY, Minckler DS
Medicine (Baltimore). 2015;94:e1045.

Study Summary

After tube-shunt surgery, the choices for further surgical intervention are often limited, because the conjunctiva may be scarred and not amenable to further manipulation. Such interventions as Trabectome, which is traditionally performed before filtering surgery for early to moderate glaucoma, would therefore be optimal for avoiding conjunctival-based surgery.

This retrospective study by Mosaed and colleagues was conducted in 20 patients with prior failed tube-shunt surgery who underwent Trabectome alone to assess the efficacy of this treatment. Study endpoints included intraocular pressure (IOP), use of glaucoma medications, and secondary glaucoma surgeries. Success was defined as IOP < 21 mm Hg, IOP reduced by at least 20% from preoperative measurement, and no secondary glaucoma surgery.

Study results were promising overall, with IOP reduced from a mean of 23.7 ± 6.4 mm Hg preoperatively to 15.5 ± 3.2 mm Hg at 12 months after Trabectome (P = 0.05). During that same period, the mean number of glaucoma medications was reduced from 3.2 ± 1.5 to 2.4 ± 1.5, although this was not statistically significant (P = 0.44).

The survival rate at 12 months was 84%, with three patients requiring additional glaucoma surgery and 15 patients reaching the 12-month follow-up point. There were no adverse events other than failure of IOP control and transient hypotony (IOP < 3 mm Hg) on day 1 in 2 cases.

Even though it did not result in significant reductions in medication reliance, Trabectome can be considered very promising for this indication, given its ability to significantly decrease IOP and its low side-effect profile.

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