Many Incisional Glaucoma Surgeries Require Reoperations

Surgeon preparing patient for eye surgery
Surgeon preparing patient for eye surgery
The review looked at 3 types of surgeries and patients who were treatment naïve vs those who had undergone prior surgeries.

A real-world analysis of patients being treated for primary open-angle glaucoma (POAG) with incisional surgery shows many continue to require additional surgical treatments in the years following to manage their glaucoma. 

Approximately a quarter of initial incisional glaucoma surgeries require reoperations within 5 years, according to a retrospective real-world analysis of Medicare claims published in Ophthalmology Glaucoma. The research took into account both trabeculectomy and implantable drainage device procedures. 

The review took into account 1945 patients with POAG undergoing an incisional glaucoma procedure between 2010 and 2011 and followed them for 5 years. Of those undergoing trabeculectomy, 5.3% had prior incisional surgery, and 18% of those receiving a tube shunt had prior surgery. In total, investigators reviewed 1171 trabeculectomies, 551 tube shunts procedures, and 223 EX-PRESS® (Alcon) filtration device placements. 

As time went on, complications rose across all subgroups. At 1 year, 8.8% of trabeculectomies had experienced failure along with 15.1% of EX-PRESS procedures, and 11.6% of tube shunt surgeries. For the EX-PRESS group, many of the failures occurred within the first year, according to the researchers. By year 5, failure rates for any patient who had undergone trabeculectomy was 23.5%. Patients who had an EX-PRESS device placed experienced a 37.1% failure rate, and those who received tube shunts had a 27.1% failure rate. At 5 years, 14.0% of treatment-naïve patients whose first procedure was trabeculectomy had to undergo some form of reoperation for glaucoma, as did 18.3% of those who first received EX-PRESS devices, and 15.1% of the patients who had tube shunts placed first.

Researchers found the patients who had undergone prior incisional surgery had a 5-year failure rate of 32.5% after tube shunt surgeries and 32.6% after trabeculectomy. “Among trabeculectomy patients, we found that the glaucoma reoperation rate was higher among those with prior surgery compared [with] those who were incisional surgery naïve at index (26.1% vs 14.3% by year 5),” researchers report. “In contrast, we found this was reversed for the tube-shunt patients: those with prior surgery had a lower reoperations rate than the incisional surgery naïve (12.0% vs 14.1%). Since the rates of failure among tube shunt and trabeculectomy patients with prior incisional surgery were similar (32.5% and 32.6%, respectively), this lower reoperations rate among the tube shunt patients with prior incisional surgery may be due to a lack of further surgical treatment options available despite the continued need for IOP lowering treatment.”

A limitation of the study includes an insufficient number of EX-PRESS patients with prior incisional surgery to assess the subpopulation separately. However, the researchers do note that a prior study shows this groups has a glaucoma reoperation rate of 30.6% by year 3, “a substantially higher rate of glaucoma reoperations than any of the 3-year rates reported in any group or subgroup in this study,” researchers explain. The use of administrative claims databases also created limitations.

Disclosure: Multiple study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. This research was supported by Santen USA. Please see the original reference for a full list of disclosures.


Craven ER, Singh IP, Yu TM, Rhoten S, Sadruddin OR, Sheybani A. Reoperation rates and disease costs for primary open-angle glaucoma patients in the US treated with incisional glaucoma surgery. Ophthalmol Glaucoma. Published online October 26, 2021. doi:10.1016/j.ogla.2021.10.011