Ab Interno Trabeculectomy Versus Trabeculectomy for Open-Angle Glaucoma

Ophthalmology

Seung Youn Jea, Brian A. Francis, Ghazal Vakili, Theodoros Filippopoulos,Douglas J. Rhee

119(1): 36-42 January 2012

Purpose
To compare the effect of ab interno trabeculectomy with trabeculectomy.

Design
Retrospective, cohort study.

Participants
A total of 115 patients who underwent ab interno trabeculectomy (study group) compared with 102 patients who underwent trabeculectomy with intraoperative mitomycin as an initial surgical procedure (trabeculectomy group). Inclusion criteria were open-angle glaucoma, age ≥40 years, and uncontrolled on maximally tolerated medical therapy. Exclusion criterion was concurrent surgery.

Methods
Clinical variables were collected from patient medical records.

Main Outcome Measures
Intraocular pressure (IOP) and Cox proportional hazard ratio (HR) and Kaplan–Meier survival analyses with failure defined as IOP >21 mmHg or less than 20% reduction below baseline on 2 consecutive follow-up visits after 1 month; IOP ≤5 mmHg on 2 consecutive follow-up visits after 1 month; additional glaucoma surgery; or loss of light perception vision. Secondary outcome measures include number of glaucoma medications and occurrence of complications.

Results
Mean follow-up was 27.3 and 25.5 months for the study and trabeculectomy groups, respectively. Intraocular pressure decreased from 28.1±8.6 mmHg at baseline to 15.9±4.5 mmHg (43.5% reduction) at month 24 in the study group, and from 26.3±10.9 mmHg at baseline to 10.2±4.1 mmHg (61.3% reduction) at month 24 in the trabeculectomy group. The success rates at 2 years were 22.4% and 76.1% in the study and trabeculectomy groups, respectively (P

Conclusions
Ab interno trabeculectomy has a lower success rate than trabeculectomy.

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