Trabeculectomy and Combined Phacoemulsification-Trabeculectomy: Outcomes and Risk Factors for Failure in Primary Angle Closure Glaucoma

Song, Brian J.; Ramanathan, Meera; Morales, Esteban; Law, Simon K.; Giaconi, JoAnn A.; Coleman, Anne L.

doi:10.1097/ijg.0000000000000493

Cited by 38 publications

(24 citation statements)

References 22 publications

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“…At both time points, patients having received trabeculectomy had a significantly higher IOP reduction compared to patients after XEN gelstent implantation. The changes in IOP after both procedures are similar to reported IOP changes in current literature [20][21][22][23][24]. Gedde et al reported a mean IOP reduction of 12.9 mmHg one year after trabeculectomy, which is slightly higher than the reduction 10.5 mmHg we observed but within the standard deviation range [23].…”

Section: Plos Onesupporting

confidence: 89%

Efficacy and safety of XEN®—Implantation vs. trabeculectomy: Data of a “real-world” setting

et al. 2020

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ObjectiveTo compare surgical success, postoperative intraocular pressure and complication rates between trabeculectomy and XEN gelstent surgery in a cohort of glaucoma patients in a typical clinical setting. MethodsA retrospective cohort study of consecutive patients with refractory open-angle glaucoma including patients who underwent either stand-alone XEN gelstent insertion with Mitomycin C or trabeculectomy with Mitomycin C between 2016 and 2018 at the University Eye Hospital Mainz, Germany. Primary outcome measure was the proportion of surgical success 1 year after surgery. Patients with an IOP �18mmHg, an intraocular pressure reduction of >20% and in no need of revision surgery or topical medication were considered a complete surgical success. If topical therapy was necessary, they were considered a qualified success. Multivariable logistic regression analysis was carried out for the primary outcome including gender, age, preoperative intraocular pressure and number of medication classes used preoperatively as adjustment variables. Results171 eyes of 144 patients were included, including 82 eyes of 58 patients in the XEN group and 89 eyes of 86 patients in the trabeculectomy group. The primary outcome defined as the proportion of surgical success after 1 year (mean 11.1 months ± 2.2) was similar for both groups. The complete success proportion was 65.5% (95%-CI: 55.6-75.9%) in the trabeculectomy group, and 58.5% (95%-CI: 47.6-69.4%) in the XEN group and not statistically different in our analysis model (crude OR = 0.61; 95%-CI: 0.31-1.22; adjusted OR = 0.66; 95%-CI: 0.32-1.37). The intraocular pressure reduction, as secondary outcome measure, was higher in the trabeculectomy group (10.5 mmHg) compared to the XEN group (7.2 mmHg; p = 0.003) at the 12-month follow-up.Citation: Wagner FM, Schuster AK-G, Emmerich J, Chronopoulos P, Hoffmann EM (2020) Efficacy and safety of XEN®-Implantation vs. trabeculectomy: Data of a "real-world" setting. PLoS ONE 15(4): e0231614. https://doi.org/10.

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Section: Plos Onesupporting

confidence: 89%

Efficacy and safety of XEN®—Implantation vs. trabeculectomy: Data of a “real-world” setting

et al. 2020

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“…Similarly, the mean number of IOP-lowering medications used at 24 months was not statistically significantly different between treatment groups [30], suggesting limited long-term effectiveness of the device. We did not expect to see additional IOP lowering in the phaco + implant group, because many studies looking at trabeculectomy and phaco-trabeculectomy have shown comparable IOP lowering with both procedures [31][32][33][34][35][36][37][38]. Both phacoemulsification and trabeculectomy techniques have evolved, which might explain why more recent papers report no differences in outcomes between trabeculectomy alone vs combined with phacoemulsification.…”

Section: Discussionmentioning

confidence: 99%

Two-year results of a multicenter study of the ab interno gelatin implant in medically uncontrolled primary open-angle glaucoma

Reitsamer

Sng

Vera³

et al. 2019

Graefes Arch Clin Exp Ophthalmol

173

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Purpose To evaluate the effectiveness of an ab interno subconjunctival gelatin implant as primary surgical intervention in reducing intraocular pressure (IOP) and IOP-lowering medication count in medically uncontrolled moderate primary openangle glaucoma (POAG). Methods In this prospective, non-randomized, open-label, multicenter, 2-year study, eyes with medicated baseline IOP 18-33 mmHg on 1-4 topical medications were implanted with (phaco + implant) or without (implant alone) phacoemulsification. Changes in mean IOP and medication count at months 12 (primary outcomes) and 24, clinical success rate (eyes [%] achieving ≥ 20% IOP reduction from baseline on the same or fewer medications without glaucoma-related secondary surgical intervention), intraoperative complications, and postoperative adverse events were assessed. Results The modified intent-to-treat population included 202 eyes (of 218 implanted). Changes (standard deviation) in mean IOP and medication count from baseline were − 6.5 (5.3) mmHg and − 1.7 (1.3) at month 12 and − 6.2 (4.9) mmHg and − 1.5 (1.4) at month 24, respectively (all P < 0.001). Mean medicated baseline IOP was reduced from 21.4 (3.6) to 14.9 (4.5) mmHg at 12 months and 15.2 (4.2) mmHg at 24 months, with similar results in both treatment groups. The clinical success rate was 67.6% at 12 months and 65.8% at 24 months. Overall, 51.1 (12 months) and 44.7% (24 months) of eyes were medication-free. The implant safety profile compared favorably with that published for trabeculectomy and tube shunts. Conclusions The gelatin implant effectively reduced IOP and medication needs over 2 years in POAG uncontrolled medically, with an acceptable safety profile. ClinicalTrials.gov registration number: NCT02006693 (registered in the USA).

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“…Traditionally, trabeculectomy and aqueous tube shunts have been the primary approaches for patients with moderate to severe CACG with poorly controlled IOP. [1213] While trabeculectomies and tubes have been shown to significantly lower IOP, they are associated with significant complications. [12] The rate of reoperation in the Tube Versus Trabeculectomy (TVT) study was 9% in the tube group and 29% in the trabeculectomy group at 5 years.…”

Section: Discussionmentioning

confidence: 99%

“…[1213] While trabeculectomies and tubes have been shown to significantly lower IOP, they are associated with significant complications. [12] The rate of reoperation in the Tube Versus Trabeculectomy (TVT) study was 9% in the tube group and 29% in the trabeculectomy group at 5 years. [14] These incisional surgeries can result in failure due to scarring, decreased quality of life due to bleb-related foreign body sensation, induced astigmatism, and secondary cataracts.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of early postoperative complications within the first month after trabeculectomy was 37% in the TVT study and 50% in the Collaborative Initial Glaucoma Treatment Study (CIGTS). [1216] In a multicenter randomized clinical trial, the Advanced Glaucoma Intervention Study (AGIS) reported the following postoperative complication rates after trabeculectomy: shallow or flat anterior chamber in 17.3%, wound leak in 6.5%, choroidal effusion in 7.9%, anterior chamber bleeding in 11.4%, and encapsulated blebs in 14.1%. [17] The TVT study reported the following postoperative rates: suprachoroidal hemorrhage in 3%, endophthalmitis in 5%, bleb leak in 6%, and cystoid macular edema (CME) in 3%.…”

Section: Discussionmentioning

confidence: 99%

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Surgical outcomes of phacoemulsification/goniosynechialysis with and without endocyclophotocoagulation in patients with chronic angle closure glaucoma

Panse

Hubbell

et al. 2019

Indian J Ophthalmol

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Purpose: To compare surgical outcomes of patients after phacoemulsification with goniosynechialysis (phaco/GSL) versus phaco with GSL and endocyclophotocoagulation (phaco/GSL/ECP) in patients with chronic angle closure glaucoma (CACG) through 12-month follow-up. Methods: A retrospective, nonrandomized, comparative case series was performed. Patients with CACG who underwent phaco in combination with either GSL alone (group 1) or GSL with ECP with intracameral injection of kenalog (group 2) from 2011 to 2018 were included. Group 1 included 6 eyes of 6 patients and group 2 included 11 eyes of 10 patients. All surgeries were performed by a single surgeon (RSA). Primary outcome measures included changes in intraocular pressure (IOP), visual acuity (VA), failure based on IOP (>18 or <6 mmHg at 1 year), and secondary operative procedures and complication rates. Data were analyzed using a paired two-tailed T -test. Results: The mean preoperative IOP decreased from 23.5 ± 11.2 to 14.2 ± 2.4 mmHg ( P < 0.0073) in group 1 and 24.4 ± 8.2 to 14.5 ± 2.7 mmHg ( P < 0.0001) in group 2. The mean % IOP reduction was 33.7% in group 1 and 34.2% in group 2. The mean improvement in VA (logMAR units) was 0.24 ( P = 0.085) in group 1 and 0.13 ( P = 0.657) in group 2. The mean number of topical meds decreased from 2.50 ± 1.76 to 1.80 ± 1.64 in group 1 ( P = 0.513) and from 2.82 ± 1.25 to 1.17 ± 0.98 in group 2 ( P = 0.014). Conclusion: Phaco/GSL and phaco/GSL/ECP both achieve a significant reduction in IOP without the complications associated with traditional glaucoma filtration surgeries.

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Trabeculectomy and Combined Phacoemulsification-Trabeculectomy: Outcomes and Risk Factors for Failure in Primary Angle Closure Glaucoma

Cited by 38 publications

References 22 publications

Efficacy and safety of XEN®—Implantation vs. trabeculectomy: Data of a “real-world” setting

Efficacy and safety of XEN®—Implantation vs. trabeculectomy: Data of a “real-world” setting

Two-year results of a multicenter study of the ab interno gelatin implant in medically uncontrolled primary open-angle glaucoma

Surgical outcomes of phacoemulsification/goniosynechialysis with and without endocyclophotocoagulation in patients with chronic angle closure glaucoma

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