Efficacy and Safety of Trabeculectomy Versus Nonpenetrating Surgeries in Open-angle Glaucoma: A Meta-analysis.
Gabai Andrea, Cimarosti Rossella, Battistella Claudio, Isola Miriam, Lanzetta Paolo
AI Summary
This meta-analysis found trabeculectomy lowers IOP more effectively than nonpenetrating surgeries for open-angle glaucoma, but carries a higher risk of complications. This guides surgical selection based on IOP target and risk tolerance.
Abstract
Purpose
The purpose of this study was to conduct a meta-analysis on the efficacy and safety of trabeculectomy (TE) and nonpenetrating glaucoma surgery (NPGS) techniques in patients with primary open-angle glaucoma, pseudoexfoliation glaucoma, pigmentary glaucoma, and normal-tension glaucoma.
Methods
All studies were identified by searching electronic sources (PubMed, Medline, Scopus, and Embase) until February 5, 2018. Primary outcome was mean intraocular pressure (IOP) reduction at 6, 12, and 24 months. Complications, number of antiglaucomatous medications, and visual outcomes were also evaluated.
Results
Twenty-one studies were included. Ten studies compared TE with deep sclerectomy (DS), 5 with viscocanalostomy (VC), 1 study with both DS and VC, and 5 with canaloplasty (CP). TE was superior to DS, VC, and CP in reducing IOP at 6 and 12 months, and to DS at 24 months. When comparing TE to VC and to CP at 24 months, there was no significant difference in IOP reduction. Hypotony, choroidals, anterior chamber shallowing or flattening, and cataract formation or progression were more associated with TE than with NPGSs. TE was more effective in reducing antiglaucomatous medications than VC and CP.
Conclusions
TE is more effective in reducing IOP. TE presents a higher risk of complications as compared with NPGS, except for hyphema.
MeSH Terms
Shields Classification
Key Concepts5
Trabeculectomy (TE) was superior to deep sclerectomy (DS), viscocanalostomy (VC), and canaloplasty (CP) in reducing intraocular pressure (IOP) at 6 and 12 months in patients with primary open-angle glaucoma, pseudoexfoliation glaucoma, pigmentary glaucoma, and normal-tension glaucoma.
Trabeculectomy (TE) was superior to deep sclerectomy (DS) in reducing intraocular pressure (IOP) at 24 months in patients with primary open-angle glaucoma, pseudoexfoliation glaucoma, pigmentary glaucoma, and normal-tension glaucoma.
There was no significant difference in intraocular pressure (IOP) reduction when comparing trabeculectomy (TE) to viscocanalostomy (VC) and to canaloplasty (CP) at 24 months in patients with primary open-angle glaucoma, pseudoexfoliation glaucoma, pigmentary glaucoma, and normal-tension glaucoma.
Hypotony, choroidals, anterior chamber shallowing or flattening, and cataract formation or progression were more associated with trabeculectomy (TE) than with nonpenetrating glaucoma surgeries (NPGSs) in patients with primary open-angle glaucoma, pseudoexfoliation glaucoma, pigmentary glaucoma, and normal-tension glaucoma.
Trabeculectomy (TE) was more effective in reducing antiglaucomatous medications than viscocanalostomy (VC) and canaloplasty (CP) in patients with primary open-angle glaucoma, pseudoexfoliation glaucoma, pigmentary glaucoma, and normal-tension glaucoma.
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