Comparison of Outcomes of Ab Interno Trabeculotomy in Pseudoexfoliative Patients with and without Prior Trabeculectomy

Purpose: To evaluate and compare the outcome of Trabectome procedure on pseudoexfoliative (PEX) Glaucoma patients with and without prior Trabeculectomy.Methods: Patients diagnosed as PEX glaucoma were divided into two separate based on the history of trabeculectomy prior to Trabectome surgery (with prior trabeculectomy group: WPT, without prior trabeculectomy group: WOT). Those with incomplete preoperative or follow-up data were excluded. Multiple imputation was utilized to avoid eliminating data with missing values. Groups were then matched using Coarsened Exact Matching based on age, baseline IOP, number of preoperative glaucoma medication, lens status, if combined with Phaco and length of follow up. Wilcox test was performed to compared IOP and glaucoma medications on different follow-up visits. Kaplan Meier plots were used to estimate success rate at 12 month follow-up visit for two groups. Failure was defined as IOP more than 21 mmHg, IOP reduced by less than or equal to 20% from baseline on any two consecutive visits after 3 months, or if additional glaucoma surgery was needed. Results: 86 patients (43 patients each) were matched and included in this study. For whole cohort and at 12 month follow-up, IOP was reduced by 25% from 24.1±6.4 mmHg to 18.1±8.0 mmHg (p<0.01), and medications was reduced by 21% from 2.8±1.3 to 2.2±1.6 (p=0.01 ). Estimated survival rate at 12 months was 90% for WPT group and 86% for WOT group and the difference was not statistically significant (p=0.40). Conclusion: The effect of Trabectome seems to be unaffected by previous trabeculectomy surgery in pseudoexfoliative glaucoma cases. Trabectome could be used as an effective surgical option in those with failed trabeculectomy.