Outcomes of ab interno trabeculectomy with the trabectome after failed trabeculectomy

Aim To evaluate outcomes of ab interno trabeculectomy (AIT) with the trabectome following failed trabeculectomy. Methods Prospective study of AITs and phaco-AITs after a failed trabeculectomy. The indication for AIT was intraocular pressure (IOP) above target on maximally tolerated therapy, and for phaco-AIT a visually significant cataract and need to lower IOP or glaucoma medications. Outcomes included IOP, medications, complications, secondary procedures and success, defined as IOP of less than 21 mm Hg and a greater than 20% reduction from baseline without further surgery. Exclusion criteria were trabeculectomy less than 3 months prior to AIT or follow-up under 1 year. Results Seventy-three eyes of 73 patients with 1 year follow-up were identified. At 1 year, mean IOP in AIT significantly decreased by 28% from 23.7 +/- 5.5 mm Hg, and medications from 2.8 +/- 1.2 to 2 +/- 1.3 (n=58). In phaco-AIT, the mean IOP decreased 19% from 20 +/- 5.9 mm Hg and medications from 2.5 +/- 1.5 to 1.6 +/- 1.4 (n=15). Transient hypotony occurred in 7%, and further surgery was necessary in 18%. For AIT and phaco-AIT, the 1-year cumulative probability of success was 81% and 87%, respectively. Conclusions Both AIT and phaco-AIT showed a reduction in IOP and medication use after 1 year, suggesting that AIT with or without cataract surgery is a safe and effective option following failed trabeculectomy.