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Editors Selection IGR 13-2

Surgical Treatment: Trabeculectomy vs Trabectome

Comment by Sameh Mosaed on:

47623 Ab Interno Trabeculectomy Versus Trabeculectomy for Open-Angle Glaucoma, Jea SY; Francis BA; Vakili G et al., Ophthalmology, 2011;

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Jea et al. (2104) compared 102 patients who underwent trabeculectomy with MMC to 115 patients who underwent ab interno trabeculectomy with the TrabectomeTM procedure. This was a retrospective analysis, where failure was defined as IOP greater than 21 mmHg or less than 20% reduction below baseline, hypotony, or loss of LP vision. The subjects were followed for a mean of 27.3 months for the trabectome^TM group and 25.5 months for the trabeculectomy group.

The TrabectomeTM procedure will likely not be a replacement for trabeculectomy, but rather represents a lower risk procedure better suited for less severe cases where a somewhat higher IOP would be adequate

The results showed a higher success rate with the trabeculectomy group than with the trabectome^TM group at two years (76.1% and 22.4%, respectively). The trabeculectomy group also had fewer additional surgeries than the Trabectome group. The complication rates were higher for trabeculectomy than for Trabectome^TM subjects. The mean post -operative IOP in the Trabectome^TM group was 15.9 mmHg and for the trabeculectomy group was 10.2 mmHg. This study re-emphasizes the results that have been published in prior works, showing that this trabecular bypass procedure typically results in IOP in the mid teens and rarely achieves single digit or low-teens IOP. This is in contrast to trabeculectomy which is still the most effective IOP- lowering procedure commonly performed. This greater efficacy however comes with higher risks and complication rates. The results of this study highlight that the Trabectome^TM procedure will likely not be a replacement for trabeculectomy, but rather represents a lower risk procedure better suited for less severe cases where a somewhat higher IOP would be adequate.

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