To assess the effect of selective laser trabeculoplasty (SLT) following failed phacoemulsification cataract extraction combined with ab interno trabeculectomy (AIT) using the Trabectome (phaco-trabectome).

Randomized, interventional case series.

Retrospectively, the medical records of patients who underwent SLT between March 2010 and July 2012 by 1 surgeon at a single center after a failed phaco-AIT were evaluated. Inclusion criteria were age ≥18 years with no upper limit and prior failed phaco-AIT attributable to glaucoma progression. Exclusion criterion was performance of any additional glaucoma procedure with influence on intraocular pressure (IOP) during follow-up and a follow-up after surgery of <3 months. Success was defined by reduction of IOP of >3 mm Hg and 20% and number of antiglaucoma medications equal to or less than baseline. Main outcome measures were IOP, antiglaucoma medications, time to failure, and Kaplan-Meier survival curve.

Fourteen eyes of 13 subjects were included. Mean follow-up after SLT was 12.9 ± 8.7 months. Total laser energy was 59.5 ± 8.7 mJ. Baseline IOP was 17.9 ± 3.3 mm Hg and number of antiglaucoma medications at baseline was 2.0 ± 1.0. All SLT procedures failed. Median time to failure after SLT was 3.6 ± 0.8 (range 2.1-5.1) months. Number of antiglaucoma medications did not change.

In eyes in which the IOP was no longer controlled following phaco-trabectome, SLT had a limited duration of significant IOP-lowering effect. Other alternatives, such as incisional filtration surgery, should be considered following failed phaco-trabectome.