Peter Cui1,2, Alp Atik1, Michelle Baker1, Lei Liu1, Hye Jin Kwon1, Qin Qin Liu1, George Kong1, Jennifer Fan Gaskin1
Purpose: To assess the management options for tra- beculectomy failure by comparing the outcomes of three surgical procedures in a tertiary referral glaucoma unit.
Methods: A retrospective chart review of 121 patients (135 cases) who underwent: (1) tube shunt surgery (31 cases), (2) bleb needle revision (79 cases) or (3) revision trabeculectomy (25 cases) between November 2010 and June 2016 at the Royal Victorian Eye and Ear Hospital. Surgical out- comes based on guidelines from the World Glau- coma Association.
Results: Mean follow-up was 13.8 9.0 months. Complete success rates at 2-years for the tube, nee- dling and revision groups were 12.9%, 29.1% and 32.0%, respectively (P = 0.151), while qualiﬁed suc- cess rates were 74.2%, 59.5% and 48.0%, respec- tively (P = 0.197). Mean IOP reduction from baseline at 2-years was similar for the tube, nee- dling and revision groups at 38.6%, 41.5%, and 43.2% respectively (P = 0.941). Early postoperative hypotony was higher in the needling and revision groups compared to the tube group (53.2% and 52.0% respectively, vs. 38.6%) (P = 0.067). How- ever, endophthalmitis was more frequent in the tube group compared to the needling or revision groups (9.7% vs. 1.3% and 4.0% respectively) (P = 0.083). Higher preoperative IOP (P = 0.029) and increased number of previous needlings were associated with failure in the needling group (P = 0.009).
Conclusion: Tube shunt surgery demonstrated a trend towards a lower failure rate than bleb needle revision and revision trabeculectomy. Higher preop- erative IOP and increased number of previous nee- dlings are risk factors for failure in eyes undergoing bleb needle revision.