title: Effect of a failed trabectome on subsequent trabeculectomy.
abstract: OBJECTIVE
  To determine the effect of a failed trabectome on the outcomes of a subsequent trabeculectomy.
  
  
  METHODS
  A cohort study of eyes that underwent trabeculectomy after a failed trabectome procedure (study) compared with eyes that underwent trabeculectomy as an initial surgical procedure (control). Inclusion criteria were open-angle glaucoma, age ≥18 years, and uncontrolled glaucoma with maximally tolerated medical therapy. Exclusion criteria were concurrent surgery and follow-up less than 6 months. Outcome measures were intraocular pressure (IOP), success rate, and occurrence of complications. Failure was the occurrence of additional glaucoma surgery, loss of light perception vision, or IOP >21 mm Hg, ≤5 mm Hg, or <20% reduction below baseline on 2 consecutive follow-up visits after 1 month.
  
  
  RESULTS
  Mean follow-up was 15.4 months and 18.6 months for study (n=34) and control (n=42) groups, respectively. IOP decreased from 27.6±11.8 mm Hg at baseline to 10.6±2.6 mm Hg at 2 years in study group, and 29.2±11.4 mm Hg to 11.0±5.4 mm Hg in the control group. The success rates at 2 years were 60.2% and 55.5% in the study and control groups, respectively (P=0.895). Systemic hypertension [P=0.009; adjusted hazard ratio, 4.03; 95% confidence interval, 1.41-11.53] and number of the preoperative antiglaucoma medications (P=0.005; 2.29; 1.28 to 4.11) were significant risk factors for failure in the multivariate analysis. Failed trabectome was not associated with trabeculectomy failure (P=0.899). Postoperative complications were similar.
  
  
  CONCLUSIONS
  A failed trabectome did not affect the success rate of a subsequent trabeculectomy.
authors.affiliation: Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Seung Youn
authors.initials: SY
authors.lastname: Jea
authors.forename: Sameh
authors.initials: S
authors.lastname: Mosaed
authors.forename: Steven D
authors.initials: SD
authors.lastname: Vold
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Rhee
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage; D001082:Aqueous Humor / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D012086:Reoperation; D014065:Tonometry, Ocular; D014129:Trabecular Meshwork / Q000378:metabolism / Q000601:surgery*; D014130:Trabeculectomy; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents