Comparative outcomes between newer and older surgeries for glaucoma

Abstract

Purpose: To compare outcomes across Trabectome, iScience (canaloplasty), trabeculectomy, and aqueous shunts regarding intraocular pressure (IOP), adjunctive medications, and complications after glaucoma-only and combined glaucoma-phacoemulsification surgeries for open-angle glaucomas.

Method: A literature review compares success rates, complications, efficacy, and limitations of traditional and novel glaucoma surgical procedures.

Results: Trabectome and canaloplasty provide modest IOP reduction with minimal intraoperative or postoperative complications. Results of Baerveldt glaucoma implant IOP reduction are comparable to trabeculectomy, but typically this shunt requires more postoperative IOP-lowering medication to achieve a success rate comparable to trabeculectomy.

Conclusion: Trabeculectomy is still the most effective IOP-lowering procedure performed today but continues to have the highest serious complication rates. Trabectome and canaloplasty are reasonable surgical therapy choices for patients in which IOPs in the mid-teens seem adequate.

Figures

FIGURE 1

Intraocular pressure (IOP) during 5-year follow-up in Trabectome-only cases (N = 1287).

FIGURE 2

Adjunctive medication use during 5-year follow-up in Trabectome-only cases (N = 1287).

FIGURE 3

Intraocular pressure (IOP) during 5-year follow-up in Trabectome-phacoemulsification cases (N = 687).

FIGURE 4

Adjunctive medication use during 5-year follow-up in Trabectome-phacoemulsification cases (N = 687)

FIGURE 5

Survival curve for Trabectome-only cases (N = 1287).

FIGURE 6

Survival curve for combined Trabectome-phacoemulsification cases (N = 687).