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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)

Bottom Line: The success for Kaplan-Meier survival analysis is defined as IOP ≤21 mm Hg, IOP reduced by at least 20% from preoperative IOP, and no secondary glaucoma surgery.Mean preoperative IOP was 23.7 ± 6.4 mm Hg and mean number of glaucoma medications was 3.2 ± 1.5.At 12 months, IOP was reduced to 15.5 ± 3.2 mm Hg (P = 0.05) and number of medications was reduced to 2.4 ± 1.5 (P = 0.44).Other than failure of IOP control and transient hypotony (IOP < 3 mm Hg) day 1 in 2 cases, there were no adverse events.Trabecular bypass procedures have traditionally been considered an approach appropriate for early-to-moderate glaucoma; however, our study indicates benefit in refractory glaucoma as well.

View Article: PubMed Central - PubMed

Affiliation: From the Gavin Herbert Eye Institute (SM, GC, KYL, DSM); and Irvine School of Medicine, University of California, Irvine, California, USA (SM, GC, AH, KYL, DSM).

ABSTRACT
To evaluate the safety and efficacy of Trabectome after failed tube shunt surgery.Twenty patients with prior failed tube shunt surgery who underwent Trabectome alone were included. All patients had at least 3 months of follow-up. Outcomes measured included intraocular pressure (IOP), glaucoma medications, and secondary glaucoma surgeries. The success for Kaplan-Meier survival analysis is defined as IOP ≤21 mm Hg, IOP reduced by at least 20% from preoperative IOP, and no secondary glaucoma surgery.Mean preoperative IOP was 23.7 ± 6.4 mm Hg and mean number of glaucoma medications was 3.2 ± 1.5. At 12 months, IOP was reduced to 15.5 ± 3.2 mm Hg (P = 0.05) and number of medications was reduced to 2.4 ± 1.5 (P = 0.44). Survival rate at 12 months was 84% and 3 patients required additional glaucoma surgery with 15 patients reaching 12 months follow-up. Other than failure of IOP control and transient hypotony (IOP < 3 mm Hg) day 1 in 2 cases, there were no adverse events.Trabecular bypass procedures have traditionally been considered an approach appropriate for early-to-moderate glaucoma; however, our study indicates benefit in refractory glaucoma as well. Eyes that are prone to conjunctival scarring and hypertrophic wound healing, such as those who have failed tube shunt surgery, may benefit from procedures that avoid conjunctival incision such as Trabectome. This study indicates potential benefits in this patient population.Trabectome was safe and effective in reducing IOP at 1-year follow-up in patients with prior failed tube shunt surgery, but not effective in reducing medication reliance in these patients.

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IOP trend in patients receiving Trabectome surgery after failed tube shunt procedure. IOP = intraocular pressure.
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Figure 1: IOP trend in patients receiving Trabectome surgery after failed tube shunt procedure. IOP = intraocular pressure.

Mentions: The mean preoperative IOP was 23.7 ± 6.4 mm Hg. Postoperative IOP was 15.5 ± 3.2 mm Hg (P = 0.05∗) at 12 months. The number of glaucoma medications was reduced to 2.4 ± 1.5 (P = 0.44) at 12 months from baseline of 3.2 ± 1.5. The IOP reduction was statistically significant, but the change in medication usage was not. Figures 1 and 2 show the trend of IOP and usage of glaucoma medications, respectively.


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)

IOP trend in patients receiving Trabectome surgery after failed tube shunt procedure. IOP = intraocular pressure.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554133&req=5

Figure 1: IOP trend in patients receiving Trabectome surgery after failed tube shunt procedure. IOP = intraocular pressure.
Mentions: The mean preoperative IOP was 23.7 ± 6.4 mm Hg. Postoperative IOP was 15.5 ± 3.2 mm Hg (P = 0.05∗) at 12 months. The number of glaucoma medications was reduced to 2.4 ± 1.5 (P = 0.44) at 12 months from baseline of 3.2 ± 1.5. The IOP reduction was statistically significant, but the change in medication usage was not. Figures 1 and 2 show the trend of IOP and usage of glaucoma medications, respectively.

Bottom Line: The success for Kaplan-Meier survival analysis is defined as IOP ≤21 mm Hg, IOP reduced by at least 20% from preoperative IOP, and no secondary glaucoma surgery.Mean preoperative IOP was 23.7 ± 6.4 mm Hg and mean number of glaucoma medications was 3.2 ± 1.5.At 12 months, IOP was reduced to 15.5 ± 3.2 mm Hg (P = 0.05) and number of medications was reduced to 2.4 ± 1.5 (P = 0.44).Other than failure of IOP control and transient hypotony (IOP < 3 mm Hg) day 1 in 2 cases, there were no adverse events.Trabecular bypass procedures have traditionally been considered an approach appropriate for early-to-moderate glaucoma; however, our study indicates benefit in refractory glaucoma as well.

View Article: PubMed Central - PubMed

Affiliation: From the Gavin Herbert Eye Institute (SM, GC, KYL, DSM); and Irvine School of Medicine, University of California, Irvine, California, USA (SM, GC, AH, KYL, DSM).

ABSTRACT
To evaluate the safety and efficacy of Trabectome after failed tube shunt surgery.Twenty patients with prior failed tube shunt surgery who underwent Trabectome alone were included. All patients had at least 3 months of follow-up. Outcomes measured included intraocular pressure (IOP), glaucoma medications, and secondary glaucoma surgeries. The success for Kaplan-Meier survival analysis is defined as IOP ≤21 mm Hg, IOP reduced by at least 20% from preoperative IOP, and no secondary glaucoma surgery.Mean preoperative IOP was 23.7 ± 6.4 mm Hg and mean number of glaucoma medications was 3.2 ± 1.5. At 12 months, IOP was reduced to 15.5 ± 3.2 mm Hg (P = 0.05) and number of medications was reduced to 2.4 ± 1.5 (P = 0.44). Survival rate at 12 months was 84% and 3 patients required additional glaucoma surgery with 15 patients reaching 12 months follow-up. Other than failure of IOP control and transient hypotony (IOP < 3 mm Hg) day 1 in 2 cases, there were no adverse events.Trabecular bypass procedures have traditionally been considered an approach appropriate for early-to-moderate glaucoma; however, our study indicates benefit in refractory glaucoma as well. Eyes that are prone to conjunctival scarring and hypertrophic wound healing, such as those who have failed tube shunt surgery, may benefit from procedures that avoid conjunctival incision such as Trabectome. This study indicates potential benefits in this patient population.Trabectome was safe and effective in reducing IOP at 1-year follow-up in patients with prior failed tube shunt surgery, but not effective in reducing medication reliance in these patients.

Show MeSH
Related in: MedlinePlus