The Efficacy and Safety of Trabeculectomy after Failed Primary Glaucoma Drainage Devices.

IF 3.2 3区医学 Q2 OPHTHALMOLOGY

Ophthalmology and Therapy Pub Date : 2025-08-01 Epub Date: 2025-06-22 DOI:10.1007/s40123-025-01189-w

Daniel Wang, Zhuangjun Si, Sanjay G Asrani, Joanne C Wen, Divakar Gupta

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引用次数: 0

Abstract

Introduction: Trabeculectomy is not usually considered for uncontrolled intraocular pressure (IOP) after glaucoma drainage devices (GDD) because of concern that the conjunctiva has been violated and future trabeculectomy surgery is likely to fail due to fibrosis. We examined the clinical outcomes of patients who underwent a trabeculectomy after failed primary GDD.

Methods: This is a cross-sectional study of all patients who had a glaucoma drainage implant that failed or was inadequate in lowering IOP and underwent a trabeculectomy in the same eye from January 2016 to December 2022.

Results: A total of 23 eyes in 22 patients met our criteria. Average IOP [± standard deviation (SD)] prior to trabeculectomy was 21.7 ± 9.3 on 3.2 ± 1.3 medications. The length of follow-up was between 0.3 and 5.0 years with an average follow-up time of 2.2 years. At 1 year (n = 16), IOP was 11 ± 1.9 mm Hg on 1.8 ± 1.5 medications. At 2 years, the average IOP was 11.8 ± 4.6 on 1.9 ± 1.4 medications. At all follow-up points, the decrease in IOP and medication was statistically significant compared with baseline (paired t-tests; p < 0.05). Most postoperative complications self-resolved with medical management (three early wound leaks, two late wound leaks, two instances of hypotony maculopathy, and one instance of cystoid macular edema). One early wound leak required surgical repair. One eye underwent an additional GDD surgery, and three eyes underwent bleb needling. In all, 20 (87%) eyes at final visit were within two lines of their baseline vision prior to trabeculectomy. No eyes progressed to having no light perception visual acuity or had an ocular infection.

Conclusions: This study suggests that trabeculectomy after a GDD is an effective and safe option for IOP control and glaucoma medication reduction. In this small sample of surgical cases, complication and reoperation rates were comparable to published rates.

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原发性青光眼引流失败后小梁切除术的疗效和安全性。

导言：青光眼引流装置（GDD）术后眼压（IOP）不受控制，通常不考虑小梁切除术，因为担心结膜已被侵犯，未来小梁切除术可能因纤维化而失败。我们研究了原发性GDD失败后行小梁切除术的患者的临床结果。方法：这是一项横断面研究，研究对象是2016年1月至2022年12月期间接受青光眼引流植入物降低IOP失败或不充分并在同一只眼睛接受小梁切除术的所有患者。结果：22例患者23只眼符合标准。小梁切除术前的平均IOP[±标准差（SD）]为21.7±9.3，服用3.2±1.3种药物。随访时间为0.3 ~ 5.0年，平均随访时间为2.2年。1年后（n = 16），使用1.8±1.5种药物时，IOP为11±1.9 mm Hg。2年时，平均IOP为11.8±4.6，用药1.9±1.4次。在所有随访点，与基线相比，IOP和药物治疗的下降具有统计学意义(配对t检验；结论：本研究提示GDD后小梁切除术是控制IOP和减少青光眼药物治疗的有效且安全的选择。在这个小样本的手术病例中，并发症和再手术率与公布的率相当。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ophthalmology and Therapy OPHTHALMOLOGY-

CiteScore

4.20

自引率

3.00%

发文量

157

审稿时长

6 weeks

期刊介绍： Aims and Scope Ophthalmology and Therapy is an international, open access, peer-reviewed (single-blind), and rapid publication journal. The scope of the journal is broad and will consider all scientifically sound research from preclinical, clinical (all phases), observational, real-world, and health outcomes research around the use of ophthalmological therapies, devices, and surgical techniques. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports/series, trial protocols and short communications such as commentaries and editorials. Ophthalmology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. 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