Surgical outcomes of additional ab interno 240° suture trabeculotomy as a second surgery for patients with primary open-angle glaucoma

Trabeculectomy (TLE) is a common secondary procedure for patients with primary open-angle glaucoma (POAG) who require additional surgery after trabeculotomy (TLO). However, TLE presents substantial postoperative challenges and an increased risk of complications. We evaluated the outcomes of an additional ab interno 240° TLO using a suture in patients with POAG who had previously undergone ab externo 120° TLO with a metal probe. This retrospective study included 22 eyes from 19 patients with POAG who underwent 240° ab interno suture TLO at Kansai Medical University Hospital between January 2015 and December 2024. The parameters assessed included the interval between procedures, intraocular pressure (IOP), use of IOP-lowering medications, early complications (hyphema with niveau formation and transient IOP spikes), and surgical success (Kaplan–Meier analysis). The mean interval between surgeries was 78.1 months. At 12 months, the median IOP decreased from 18.8 mmHg to 14 mmHg. The use of IOP-lowering medications was significantly reduced for up to 3 months. Kaplan–Meier analysis showed a 50% success rate. Hyphema and transient IOP spikes occurred in 3 of 22 eyes. These findings suggest that 240° ab interno suture TLO may be a viable alternative to TLE for additional glaucoma management.