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Sameh Mosaed; Effect of Trabectome in Patients with Prior Failed Tube Shunts Surgery. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3178.
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To evaluate the safety and efficacy of Trabectome after failed Tube Shunt Surgery
24 patients with prior failed tube shunt surgery that underwent the Trabectome alone or Trabectome combined with phacoemulsification procedures were included in this study. All patients had at least 3m of follow-up. Outcomes measured included IOP, glaucoma medications and secondary glaucoma surgeries if any. The success for Kaplan Meier survival analysis is defined as IOP < 21 mmHg, IOP reduced by at least 20% from pre-operative IOP, and no secondary glaucoma surgery.
The mean pre-operative IOP was 23.0 ± 6.5 mmHg and mean number of glaucoma medications was 3.2 ± 1.4. At 12 months, IOP was reduced to 16.1 ± 4.9 mmHg (p=0.02) and number of medications was reduced to 2.4 ± 1.5 (p=0.34). The survival rate at 12 months was 83% and 3 patients required additional glaucoma surgery with 15 patients reaching 12 months follow up. 2 patients were reported with hypotony at day one, but quickly resolved.
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 respond 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 one 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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