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Glaucoma The First Decade of Global Trabectome Outcomes Sameh Mosaed Associate Professor, Cataract and Glaucoma Surgery, Ophthalmology, Director of Glaucoma Services, Department of Ophthalmology, Director of Glaucoma, Long Beach Veterans Hospital; Director of Glaucoma Fellowship, Department of Ophthalmology, Gavin Herbert Eye Institute, Department of Ophthalmology, School of Medicine, University of California, Irvine, US Abstract Purpose: To present available primary outcome results of global Trabectome experience for patients receiving Trabectome procedure including cases with up to 90 months of follow-up. Method: A total of 5,435 cases were included in the study. Baseline demographics were collected and outcome measures included intraocular pressure (IOP), number of glaucoma medications and secondary glaucoma surgery, if any. Survival analysis was performed and success was defined as IOP ≤21 mmHg, at least 20 % of IOP reduction from baseline, and no additional glaucoma surgery. Results: At 90 months, IOP was reduced from 23.0±7.9 mmHg to 16.5±3.8 mmHg (29 %) and the number of glaucoma medications was reduced from 2.6±1.3 to 1.6±1.3 (38 %). At 90 months, the survival rates were 60 % for all cases, 76 % for combined cases and 50 % for Trabectome alone cases. Discussion: These results are generally consistent with previously published outcome results for patients receiving the Trabectome procedure. Conclusion: Considering this outcome analysis of the available global Trabectome experience in combination with outcome data surveyed from the literature, patients receiving Trabectome on average have about a 30 % reduction in IOP and a 60 % reduction in glaucoma medication. The Trabectome procedure can be considered for initial glaucoma therapy, as well as for end-stage patients who have been refractory to other surgical and medical treatments. Keywords Trabectome, trabecular meshwork, glaucoma, ab-interno trabeculotomy, surgery, MIGS, trabecular bypass, Schlemm’s canal surgery, trabeculotomy Disclosure: Sameh Mosaed is a speaker for Alcon Laboratories and Allergan, and has received grant funding from Glaukos and Solx. No funding was received in the publication of this article. Compliance with Ethical Guidance: All research was conducted with local institutional review board approval and in accordance with the Declaration of Helsinki and the US Health Insurance Portability and Accountability Act. Received: 23 September 2014 Accepted: 4 December 2014 Citation: European Ophthalmic Review, 2014;8(2):113–9 Correspondence: Sameh Mosaed, Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA 92697, US. E: Glaucoma is a disease that results in degeneration of the optic disc and can lead to reduced vision and even blindness if left untreated. The purpose of this article is to provide summary results of Trabectome procedures performed between 2004 to 2014. Glaucoma remains one of the leading causes of blindness worldwide. Globally, 60.5 million people were estimated to have glaucoma in 2010, and the number is expected to increase to 79.6 million by 2020. 1 Based on population-based surveys, it is indicated that one in 40 adults older than 40 years of age has glaucoma with loss of visual function, equating to about 8.4 million being bilaterally blind. 2 risk of early hypotony, choroidal effusion, suprachoroidal haemorrhage, shallow anterior chamber, diplopia, tube obstruction, conjunctival erosion, tube migration, corneal decompensation, plate encapsulation and late failure. 7,8 Due to these high complication rates associated with filtering surgeries, the Trabectome surgical device was developed in attempt to lower IOP while minimising the risks typically associated with filtering surgeries. 11 Trabectome also has the advantage of not affecting the success rate of subsequent trabeculectomy, but same effect is not found in selective laser trabeculoplasty (SLT) after Trabectome. 12,13 Intraocular pressure (IOP) is considered to be one of the main risk factors for optic nerve damage. Hence, one of the goals of glaucoma treatment is to lower and maintain IOP control. 3–6 Available treatments for The Trabectome device was cleared by the US Food and Drug Administration (FDA) in 2004. It is designed to address the outflow resistance problems in open angle glaucoma (OAG). The device ablates a strip of trabecular meshwork and the inner wall of Schlemm’s canal and thus re-establishes outflow to the natural pathway. 14 Since the procedure glaucoma include surgical procedures and topical eye drops. Traditional filtering surgeries, such as trabeculectomy and aqueous tube shunt, are associated with potential complications. Complications associated with trabeculectomy include hypotony, hypotony maculopathy, bleb leaks, late blebitis, choroidal effusion and haemorrhage, bleb-related endophthalmitis, peripheral anterior synechiae formation, posterior synechiae and cataract formation. 7,8 The complication rates are increased when antifibrotics are used, but the short-term failure rate of trabeculectomy in the absence of antifibrotics is relatively high. 8–10 The rate of endophthalmitis is 1 % per year. 9 Aqueous tube shunt surgery has the © To u ch MEd ica l MEdia 201 4 does not involve manipulation of the conjunctiva, tenon or external eye wall, the typical complications seen in filtering surgeries are not observed after Trabectome procedures. 15 In addition, the procedure is minimally invasive and performed through a clear-corneal incision and thus can be combined with phacoemulsification and intraocular lens implantation. 16,17 A number of peer-reviewed Trabectome publications. 7,11,12,14–46 are summarised in Table 1 representing different comparative analyses of 113