Abstract
This retrospective study of 264 eyes having inferior-quadrant trabectome surgery confirms its safety and relatively effectiveness. Most patients however still require IOP-lowering agents and a considerable proportion may need additional glaucoma surgery. To report outcomes from a large single-centre cohort of inferiorly-applied trabectome surgery. Retrospective review of patients undergoing trabectome surgery for chronic open angle glaucoma (COAG) at the University Eye Clinic Bonn, Germany, from 2012 to 2020. Twohundred-sixty-four eyes of 206 patients with COAG were included. Mean review period was 45.43 (range 12-101) months. 105 eyes (39.8%) underwent standalone surgery, of which 74 were pseudophakic and 31 phakic. Mean preoperative IOP was 17.58mmHg (range 12-50mmHg). 105 eyes (39.8%) developed a 'failure event' according to pre-defined criteria at a mean interval of 14.8 months post-op. In absolute terms, 211 patients (79.9%) had a long-term IOP >14mmHg at 7.6 months, 174 patients (65.9%) >16mmHg at 10.6 months, 127 patients (48.1%) >18mmHg at 10.9 months and 77 patients (29.2%) >21mmHg at 11.1 months. Over a five-year period, overall mean IOP remained stable at 13mmHg. The majority of patients were still on glaucoma drops (mean number reduced from 2.9 to 2.7 agents). Sub-group analyses showed that higher pre-operative IOP was a positive predictor for failure whereas combined surgery (with phaco) had better IOP outcomes (16.5mmHg vs. 19.3mmHg respectively). 41 patients (15.5%) developed minor complications: 22 had high postoperative IOP within 3 months, 11 developed a self-resorbing hyphema, 6 had fibrinous uveitis. Trabectome surgery is a safe and relatively effective procedure for lowering IOP but most patients still need IOP-lowering agents and a considerable proportion may need additional glaucoma surgery within a relatively short time. Inferior quadrant treatment may result in inferior IOP outcomes when compared to nasal quadrant surgery.
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