Two-year outcomes of ab interno trabeculectomy with the Trabectome for Chinese primary open angle glaucoma: a retrospective multicenter study

Coarsened Exact Matching of Excisional to Plasma-ablative Ab Interno Trabeculectomy

Aim

To compare ab interno trabeculectomy by trabecular meshwork (TM) excision to plasma-mediated ablation in primary open-angle glaucoma (POAG) patients.

Methods

Retrospectively collected data of TrabEx+ (TEx) (n = 56) and Trabectome (T) (n = 99) patients were compared by coarsened exact matching to reduce confounding and matched based on baseline intraocular pressure (IOP) and age. The primary outcomes were IOP and the number of glaucoma medications. Complications and the need for additional glaucoma surgery were assessed. Patients were followed for up to 1 year.

Results

A total of 53 TEx could be matched to T. Baseline IOP was 16.5 ± 4.6 mm Hg in both; age was 73.7 ± 8.8 and 71.5 ± 9.9 years in TEx and T, respectively. TEx was taking more medications than T (p < 0.001). IOP was reduced to 14.8 ± 4.3 in TEx and to 13.4 ± 3.4 in T at 6 months, and to 14.9 ± 6.0 (p = 0.13) in TEx and to 14.1 ± 3.8 mm Hg (all p < 0.05) in T at 12 months. Medications were reduced at both 6 and 12 months (p < 0.05). No differences were seen between TEx and T at 6 and 12 months. In TEx, only one serious complication occurred, and two patients required further glaucoma surgery.

Conclusion

Although both groups had a baseline IOP considered low for ab interno trabeculectomy, IOP and medications were reduced further at 6 and 12 months. IOP reduction did not reach significance in TEx at 12 months. The intergroup comparison did not reveal any significant differences. Both had a low complication rate.

Clinical significance

This study investigated subtle differences between a plasma-ablative device, the T, and an excisional device, the TEx, by applying coarsened exact matching. IOP and medications were reduced in both groups at 6 and 12 months, although IOP reduction did not reach significance in TEx at 12 months. The intergroup comparison did not reveal any significant differences, with both devices having a low complication rate.

How to cite this article

Dakroub M, Verma-Fuehring R, Strzalkowska A, et al. Coarsened Exact Matching of Excisional to Plasma-ablative Ab Interno Trabeculectomy. J Curr Glaucoma Pract 2023;17(1):9-14.

Systematic Review of MIGS and Non-Penetrating Glaucoma Procedures for Uveitic Glaucoma

Minimally invasive glaucoma surgeries (MIGS) and non-penetrating glaucoma procedures have changed the surgical management of glaucoma in recent years and are being explored in the management of uveitic glaucoma. Deep sclerectomy, Xen45 gel stent, gonioscopy-assisted transluminal trabeculotomy (GATT), trabectome, and canaloplasty are described in the literature as alternative surgeries that may work for uveitic glaucoma. While most of the published studies are retrospective case series, the results suggest success even in refractory cases and with less inflammation than more traditional surgeries.

Viscotrabeculotomy versus trabeculectomy in the surgical treatment of open angle glaucoma: a single center, randomised controlled trial

PURPOSE

The aim of the study was to compare the effect of viscotrabeculotomy and the effect of trabeculectomy on the intraocular pressure (IOP) in cases of open angle glaucoma (OAG).

STUDY DESIGN

Prospective comparative study.

PATIENTS AND METHODS

The study was conducted on 148 eyes of 148 patients (87 men) presenting with and operated upon for OAG at Mansoura Ophthalmic center of Mansoura University in Mansoura, Egypt from 2012 to 2016. Patients were randomized into viscotrabeculotomy and trabeculectomy groups. Postoperative follow up visits were scheduled at weeks 1 and 2 then months 1, 2, 3, 6, 9, 12, 15, 18, 21 and 24. Complications were noted and managed according to needs. The primary outcome measure was IOP.

RESULTS

The study was conducted on 148 eyes (74 right) of 148 patients (87 men). The mean ± SD (range, median) age of the study patients was 50.1 ± 11.5 (20-67, 53) and 51.1 ± 10.0 (27-65, 54.5) years respectively. The mean ± SD (range, median) IOP of the study eyes on maximal tolerated IOP lowering therapy was 23.15 ± 2.31 (19-30, 23.0) and 23.64 ± 1.87 (20-28, 23.0) mmHg respectively and at the end of the 24 months of follow up was 14.91 ± 2.4 (12-23, 14) and 16.64 ± 2.8 (14-25, 16) mmHg respectively (p =  < 0.0005). Notable complications included a mild hyphema in the viscotrabeculotomy group and an IOP spike in the trabeculectomy group.

CONCLUSIONS

Viscotrabeculotomy and trabeculectomy showed efficacy and safety in OAG patients. The former resulted in better IOP reduction.

Effectiveness and limitations of minimally invasive glaucoma surgery targeting Schlemm's canal

Glaucoma surgery is performed to lower intraocular pressure (IOP); ideally, the IOP reduction is safely maintained for an extended period of time. Although trabeculectomy was considered the gold standard for glaucoma surgery for many years because of its effective IOP reduction, yet now it is considered unsafe because of serious complications. In recent years, minimally invasive glaucoma surgery (MIGS), which emphasizes safety and can be performed rapidly, has become widespread. Because MIGS does not involve conjunctival incisions, patients can undergo future trabeculectomy. If IOP reduction can be maintained safely, the number of anti-glaucoma drops can be reduced and visual function maintained, good outcomes for patients with glaucoma. Currently, many types of MIGS approved in Japan are reported to yield relatively good results, with targets of approximately 15-19 mmHg. However, the IOP-lowering effects of MIGS are limited. In procedures targeting Schlemm's canal, it is difficult to lower IOP beyond episcleral venous pressure. In some instances, a beneficial effect cannot be achieved if function is reduced beyond the collector channel. There are many unclear aspects regarding long-term outcomes following MIGS. Notably, investigation is ongoing to determine which patients are likely to benefit most from surgery. Based on previous reports, this review describes the characteristics and results of MIGS, approved in Japan, as well as underlying factors that affect the preoperative predictions and outcomes of the surgical procedure.

Minimally Invasive Glaucoma Surgery: What Do We Know? Where Should We Go?

With the arrival of a plethora of new and revolving minimally invasive glaucoma surgery techniques, glaucoma specialists currently are fortunate to have various surgical options that aim to recovery of the function of the aqueous outflow system in different ways. Meanwhile, the aqueous outflow system has become the hot point of researching. In ARVO 2019, a special interest group session was held on new perspectives on minimally invasive glaucoma surgery. Ten surgeons, clinical professors, and experimental scientists were invited to report their latest studies and discussed on five hot topics in this special interest group. This review summarizes the special interest group session and posts the issues of greatest concern, providing insight to the aqueous outflow system and areas that require further study.