Trabectome success factors

• Published in: Medicine (Baltimore) Vol. 96; no. 24; p. e7061
• Main Authors: Okeke, Constance O, Miller-Ellis, Eydie, Rojas, Mario
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health 01.06.2017
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Follow-Up Studies; Glaucoma - drug therapy; Glaucoma - ethnology; Glaucoma - surgery; Humans; Infant; Infant, Newborn; Intraocular Pressure; Male; Microsurgery; Middle Aged; Multivariate Analysis; Observational Study; Ophthalmologic Surgical Procedures; Proportional Hazards Models; Prospective Studies; Risk Factors; Survival Analysis; Treatment Failure; Young Adult
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000007061

Our objective is to investigate which factors and patient characteristics are associated with success in Trabectome surgery.A total of 658 phakic cases with at least of 12 months follow-up were included in the analysis. Baseline demographics and medical data were collected. The main outcome measure was intraocular pressure (IOP), glaucoma medication (Rx), and secondary glaucoma surgery if any. Success was defined as IOP reduction of 20% or more from preoperative IOP and IOP < 21 mm Hg with no secondary surgery throughout the follow-up period. Risk factors for failure were determined by using univariate and multivariate cox regression.At baseline, the average IOP was 23.6 ± 7.8 mm Hg and the average number of medications was 2.6 ± 1.3 for all cases. At 12 months, the average IOP was 16.0 ± 3.6 mm Hg (P < .01) and the average number of medications was 1.8 ± 1.3 (P < .01). Based on the result of multivariate cox regression model, we found that the Trabectome + Phaco (TP) and Trabectome alone (TA) group had a 94% and 79% survival rate at 12 months, respectively. TP cases had 78% lower risk of failure than TA (95% confidence interval [CI]: 54-89), diagnosis of pseudoexfoliation glaucoma had a 54% lower risk of failure than primary open angle glaucoma patients (95% CI: 1-78). Hispanics had an estimated hazard ratio that is 60% lower than Caucasians (95% CI: 18-80); 20% of TA cases and 3% of TP cases were required to undergo additional secondary surgery (P < .01).Trabectome surgery, whether in combination with phacoemulsification cataract removal or stand alone, is associated with a significant reduction of IOP and glaucoma medication. Patients having a higher baseline IOP are expected to have a higher IOP reduction after Trabectome. Pseudoexfoliation glaucoma, combination with phacoemulsification cataract surgery and Hispanic race are factors associated with enhanced Trabectome survival.