Glaucoma Surgery

Trabeculectomy and Tube Shunt 30-Day Infection Rates

*Glaucoma surgeries combined with cataract surgery and ExPRESS shunt were included in the analysis starting in 2019.

Some of the most common incisional surgeries performed at all surgical locations by the Glaucoma Service are trabeculectomy and tube shunt surgery.

During the 2023 calendar year, 442 trabeculectomy and tube shunt surgeries were performed. These surgeries included trabeculectomy (with or without previous scarring) on 172 eyes, and tube shunt surgeries (primary or revision) on 270 eyes. Of these, four cases were combined with other procedures, such as a keratoprosthesis implant, intraocular lens repositioning, strabismus surgery, or retinal laser surgery. Of note, 12 pediatric cases—defined as patients younger than 18 years old—were excluded from all analyses.

A review of the literature suggests that trabeculectomy and tube shunt infection rates range from 0.12% to 8.33% internationally depending, in part, on the length of follow-up.¹

Trabeculectomy and Glaucoma Tube Shunt Surgery: Intraoperative Complications

*Glaucoma surgeries combined with cataract surgery and ExPRESS shunt were included in the analysis starting in 2019.

During the 2023 calendar year, 442 trabeculectomy surgeries and glaucoma tube shunt surgeries were performed by the Glaucoma Service. Four cases that were combined with other procedures (e.g., keratoprosthesis implant, intraocular lens repositioning, strabismus surgery, or retinal laser surgery) and 12 pediatric cases—defined as patients younger than 18 years old—were excluded, which left 426 cases for analysis. Of these, 94% (400/426) of patients had no intraoperative complications. For trabeculectomy and glaucoma tube shunt surgery, similar results were reported from calendar year 2014 to 2022.

Mass Eye and Ear 2023 Complication Rates

• Conjunctival tear/buttonhole: 2.3%
• Hyphema: 2.1%
• Scleral flap trauma: 0.2%
• Vitreous loss (vitreous prolapse): 1.2%
• Suprachoroidal hemorrhage: 0.23%
• Scleral perforation: 0%
• Aqueous misdirection: 0%

The 426 cases evaluated included:

• 157 trabeculectomies without scarring
• 13 trabeculectomies with previous scarring
• 214 primary tube surgeries
• 42 tube revisions

Trabeculectomy and Tube Shunt Surgery Return to Operating Room within One Month and Six Months

Note: 2019 data on trabeculectomy and tube shunt surgeries for return to OR within 6 months were not collected.

Trabeculectomies and tube shunt implantations are the gold standard procedures for patients with glaucoma who require surgical intervention. The Glaucoma Service performed 442 trabeculectomy and tube shunt surgeries in calendar year 2023, which included 172 trabeculectomies and 270 tube shunts. Four cases that were combined with other procedures (e.g., keratoprosthesis implant, intraocular lens repositioning, strabismus surgery, or retinal laser surgery) and 12 pediatric cases—defined as patients younger than 18 years old—were excluded, which left 426 cases for analysis. Cases combined with cataract surgery and ExPRESS shunts were included. After the exclusion criteria were applied, 170 trabeculectomies and 256 tube shunt surgeries remained for analysis. Return to the operating room (OR) rates were calculated as returns within one month or returns within six months following surgery. Returns to the OR after one month but within six months were only counted in the six-month group. Reoperations were defined as cases requiring revision surgery for any surgical-related reason or for uncontrolled IOP.

Of the 170 trabeculectomies, 4.1% of cases returned to the OR within one month (7/170) and 11.2% of cases returned to the OR within six months (19/170). Of the 256 tube shunt surgeries, 2% of cases returned to the OR within one month (5/256) and 7.4% of cases returned to the OR within six months (19/256). Many of the patients who returned to the OR within six months after initial surgery did so because they required additional treatment for uncontrolled IOP.

To the best of our knowledge, published data on one month and six months reoperation rates are lacking; therefore, our reported rates will help to establish new benchmarks.