Outcomes of ab interno trabeculectomy revision with 5-flourouracil

Authors: Sunil Ruparelia, Paul Rafuse, Brennan Eadie. Author Disclosure Block: S. Ruparelia: None. P. Rafuse:None. B. Eadie: None.

Abstract Body: 

Purpose: Trabeculectomy failure associated with subconjunctival fibrosis and inadequate intraocular pressure (IOP) controlis classically addressed with needling via an ab externo approach. However, the traditional needling approach often nessecitates multiple neddling attempts. This study seeks to describe the outcomes of patients who underwent ab interno trabeculectomy revision with a translimbal sclerostomy spatula.

Study Design: Retrospective chart review.

Methods: This retrospective chart review identified patients with advanced glaucomatous optic neuropathy (GON) who had undergone ab interno trabeculectomy revision during a 5-year period at a single center in Nova Scotia, Canada. All ages and glaucoma subtypes treated were included. Patients who underwent combined revision and cataract surgery were excluded. Outcomes measures included: change in IOP, number of topical glaucoma medications, best-corrected visual acuity (BCVA), visual field mean deviation (MD), and post-operative complications.

Results: This study included 46 eyes of 46 patients. Success, defined as IOP ≤14 mmHg at the last follow- up was achieved by 50% of patients without topical glaucoma drops (complete success) and 8.8% of patients with topical glaucoma drops (qualified success). Statistically significant reduction in IOP was observed at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months post-operative follow-up. No significant change in visual acuity or mean deviation of visual field was observed. No statistically significant difference was demonstrated when baseline visual acuity and visual acuity at any follow-up were compared. However, our results suggest that patients can be expected to return to their baseline Snellen visual acuity 1 month following revision. Early hypotony was noted in 67.6% of eyes but was not associated with negative visual acuity or visual field outcomes.

Conclusions: Ab interno revision trabeculectomy is associated with favourable outcomes in managing trabeculectomy failure; however, early post-operative hypotony should be expected.