Comparison of subconjunctival microinvasive glaucoma surgery and trabeculectomy.
Wagner Felix M, Schuster Alexander K, Munder Annika, Muehl Marius, Chronopoulos Panagiotis, Pfeiffer Norbert, Hoffmann Esther M
AI Summary
This study compared XEN, Preserflo, and trabeculectomy for refractory glaucoma. While all achieved low IOP, trabeculectomy reduced IOP more. All three are viable options, informing individualized treatment decisions.
Abstract
Purpose
To assess surgical success and the post-operative development of intraocular pressure between XEN45 ® gelstent, Preserflo ® MicroShunt and trabeculectomy with mitomycin C.
Methods
Data from 105 eyes from 105 patients of matched cases with refractory open-angle glaucoma, who underwent surgery between January 2019, and August 2020, were evaluated. Patients underwent either stand-alone XEN gelstent insertion with Mitomycin C, stand-alone Preserflo with Mitomycin C or trabeculectomy with Mitomycin C. The primary outcome was the proportion of complete surgical success at 6 months post-operatively (i.e. intraocular pressure between 5mmHg and 18mmHg, no revision surgery, no loss of light perception and no post-operative pharmaceutical antiglaucomatous treatment). The reduction of intraocular pressure after 6 months, the classes of antiglaucomatous medication used post-operatively, best-corrected visual acuity, spherical refractive errors and astigmatism were assessed as secondary outcomes.
Results
We included 35 eyes in each group. After 6-month follow-up, complete success was 73.5% [95%-CI: 57.9%-89.2%] in the trabeculectomy group, 51.4% [95%-CI: 34.0%-68.8%] in the XEN group and 74.2% [95%-CI: 57.9%-90.5%] in the Preserflo group (p = 0.08). Regarding secondary outcomes, the reduction of intraocular pressure was 12.1 ± 7.9 mmHg in the trabeculectomy group and was thereby 5.8 [95%-CI: 2.2-9.6] mmHg greater compared with the XEN group (p < 0.001) and 4.8 [95%-CI: 0.9-8.7] mmHg higher than the Preserflo group (p = 0.01).
Conclusions
No statistically significant differences were found between trabeculectomy, XEN45 ® gelstent implantation and Preserflo ® MicroShunt implantation regarding surgical success after 6 months. Yet reduction in intraocular pressure was significantly higher in the trabeculectomy group. However, all three interventions resulted in sufficiently low post-operative intraocular pressure and may therefore be considered individually for glaucoma treatment.
MeSH Terms
Shields Classification
Key Concepts4
After a 6-month follow-up period, the complete surgical success rate for trabeculectomy with mitomycin C was 73.5% [95%-CI: 57.9%-89.2%], for the XEN45® gelstent it was 51.4% [95%-CI: 34.0%-68.8%], and for the Preserflo® MicroShunt it was 74.2% [95%-CI: 57.9%-90.5%] in a matched case study of 105 eyes from 105 patients with refractory open-angle glaucoma.
No statistically significant differences were found between trabeculectomy with mitomycin C, XEN45® gelstent implantation, and Preserflo® MicroShunt implantation regarding surgical success after 6 months (p = 0.08) in a matched case study of 105 eyes from 105 patients with refractory open-angle glaucoma.
The reduction of intraocular pressure was 12.1 ± 7.9 mmHg in the trabeculectomy group, which was 5.8 [95%-CI: 2.2-9.6] mmHg greater compared with the XEN45® gelstent group (p < 0.001) and 4.8 [95%-CI: 0.9-8.7] mmHg higher than the Preserflo® MicroShunt group (p = 0.01) after 6 months in a matched case study of 105 eyes from 105 patients with refractory open-angle glaucoma.
All three interventions, XEN45® gelstent, Preserflo® MicroShunt, and trabeculectomy with mitomycin C, resulted in sufficiently low post-operative intraocular pressure and may therefore be considered individually for glaucoma treatment in patients with refractory open-angle glaucoma.
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