Outcomes of Second Trabeculectomy Versus Glaucoma Drainage Device in Juvenile Open Angle Glaucoma After Primary Trabeculectomy Failure.

Abstract

Prcis: Second trabeculectomy and glaucoma drainage device implantation offer similar success rates for juvenile open angle glaucoma after initial trabeculectomy failure. However, second trabeculectomies required fewer medications. A quarter of patients in both groups required a third operation after 2.5±2.3 years.

Purpose: To compare outcomes between second trabeculectomy surgery versus glaucoma drainage device (GDD) insertion in juvenile open angle glaucoma (JOAG) patients after primary trabeculectomy failure.

Method: A retrospective review was performed on all JOAG patients who underwent a second glaucoma surgery after primary trabeculectomy failure across 2 tertiary hospitals in Bangkok, Thailand between 2009 and 2020. Demographics, intraoperative reports, and clinical findings were collected. The primary outcomes were complete and qualified success rates at 5 years; secondary outcomes included differences in intraocular pressures and a number of glaucoma medications postoperatively.

Results: Fifty-two eyes of 38 patients underwent a second glaucoma surgery after primary trabeculectomy: 30 had a second trabeculectomy, 17 received a GDD (10 valved, 7 non-valved), and 5 underwent cyclophotocoagulation. Before surgery, there were no significant differences except in mean refractive error. The average follow-up length was 66.9±53.7 months. Qualified success rates were 81.5% and 63.2% at 3 and 5 years (complete success: 55.6% and 42.1%) for the second trabeculectomy group and 80.0% and 70.0% (complete success: 53.3% and 50.0%) for the GDD group, respectively. There were no significant differences in group success or IOP postoperatively. The GDD group required more medications at 5 years (1.3±1.9 vs. 2.3±1.5, P =0.03). Two cases of tube exposure in the GDD group resulted in implant removal. About a quarter of patients in both groups required a third operation after 2.5±2.3 years.

Conclusion: Both second trabeculectomy and GDD insertion are effective treatments for JOAG after trabeculectomy failure. The second trabeculectomy required fewer medications for intraocular pressure control.