Outcomes of Salvage Trabeculectomy in Japanese Patients with Open-Angle Glaucoma and Persistent Intraocular Pressure Elevation Following Trabectome or Microhook Ab Interno Trabeculotomy.

Background/

Objectives

The objective was to describe the one-year outcomes of salvage trabeculectomy (TLE) in eyes with persistent elevation of intraocular pressure (IOP) requiring early surgical intervention after failed minimally invasive glaucoma surgery (MIGS).

Methods

This retrospective observational study included 38 eyes of 38 consecutive Japanese patients who underwent TLE within 100 days after Trabectome (TOM) or microhook ab interno trabeculotomy (μTLO) because of uncontrolled IOP despite maximally tolerated medical therapy. Surgical success was defined as (1) IOP reduction ≥30% from baseline, (2) 5 < IOP < 18 mmHg, (3) no additional glaucoma surgery, and (4) no loss of light perception. The Kaplan-Meier method was used to estimate the one-year success rate. Changes in IOP, medication use, best-corrected visual acuity (BCVA), and mean deviation (MD) were analyzed using the Wilcoxon matched-pairs signed-rank test and a linear mixed-effects model.

Results

The median interval between MIGS and TLE was 41.5 days (interquartile range, 28-70 days). The one-year surgical success rate was 86.8% (Kaplan-Meier estimate). IOP and medication use were significantly reduced after TLE (p < 0.0001) and remained stable throughout the 12-month follow-up. BCVA did not differ significantly between baseline and 12 months after TLE, whereas a small but statistically significant difference in MD was observed. No serious vision-threatening complications were encountered.

Conclusions

TLE performed shortly after failed MIGS achieved substantial IOP reduction with acceptable safety over a one-year follow-up period. TLE may be considered as one of the surgical options in cases where sufficient IOP reduction cannot be achieved after failed MIGS, and no effective alternative treatments are available.