Two Year Functional and Structural Changes—A Comparison between Trabeculectomy and XEN Microstent Implantation Using Spectral Domain Optical Coherence Tomography

Abstract

The aim of this study was to analyze retinal nerve fiber layer (RNFL) thickness after trabeculectomy (TE) versus XEN microstent implantation (XEN) in primary open-angle glaucoma (POAG) cases naïve to prior incisional glaucoma surgery. We examined 119 consecutive glaucoma patients retrospectively, who received a TE or XEN for medically uncontrolled POAG. Intraocular pressure (IOP), amount of IOP-lowering medication, mean deviation of standard automated perimetry and peripapillary RNFL thickness were evaluated during the first 24 months after surgery. Fifty eyes were treated with TE and 69 eyes with XEN. Mean IOP decreased from 25.1 ± 0.8 to 13.3 ± 0.6 mmHg (p < 0.01) and mean number of IOP-lowering eye drops from 3.2 ± 0.2 to 0.4 ± 0.1 (p < 0.01) 24 months after TE. In 69 eyes undergoing XEN, mean IOP dropped from 24.8 ± 0.6 to 15.0 ± 0.4 mmHg (p < 0.01) and medication from 3.0 ± 0.1 to 0.6 ± 0.1 (p < 0.01) during the 24 months follow-up. Mean deviation of standard automated perimetry remained stable in TE (8.5 ± 0.7 to 8.1 ± 0.8 dB; p = 0.54) and XEN group (11,0 ± 0.5 to 11.5 ± 0.5 dB; p = 0.12) after 24 months, while mean RNFL thickness further deteriorated in the TE (−2.28 ± 0.65 µm/year) and XEN (−0.68 ± 0.34 µm/year) group. Postoperative RNFL loss develops after TE and XEN despite effective and significant lowering of IOP and amount of IOP-lowering medication. RNFL loss was more pronounced in the first year after glaucoma surgery.

Functional and Morphological Outcomes after Trabeculectomy and Deep Sclerectomy—Results from a Monocentric Registry Study

“…These developments are comparable to the results observed in our TE group. However, we added further descriptions of functional (visual field test) and anatomical (RNFL thickness) development after surgery, adding to the already published knowledge about the effectiveness of TE [ 11 , 20 , 21 ].…”

“…To date, limited data exist concerning the long-term structural and functional outcomes after TE and DS. However, it has been shown before that after surgical glaucoma intervention, further RGC loss develops although sufficient IOP decrease [ 11 ].…”

PRESERFLO MicroShunt implantation versus trabeculectomy for primary open-angle glaucoma: a two-year follow-up study

“…Several studies have shown that RGC loss continues after glaucoma surgery. In another study of POAG eyes that underwent TE or XEN microstent implantation, we already demonstrated that although the preoperative target IOP levels were achieved, the peripapillary RNFL thickness continued to decrease during the first year after surgery and remained stable during the second year after surgery [ 38 ]. This further RNFL loss occurred without evidence of further functional deterioration and was more pronounced in the TE group than in the XEN implantation group.…”