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Safety and efficacy of canaloplasty versus trabeculectomy in treatment of glaucoma.

ABSTRACT: We assess the efficacy and safety of canaloplasty and trabeculectomy for treatment of glaucoma. We searched the China National Knowledge Infrastructure, PubMed, Web of Science, and WanFang databases for potentially eligible studies. Pooled risk ratio (RR) with 95% confidence interval (CI) was calculated using random- or fixed-effect models if appropriate. Eight studies were included for meta-analysis. There was no difference in intraocular pressure at 6 months (WMD = 0.97, 95%CI: -0.48-2.41). Intraocular pressure in canaloplasty group 12 months after operation was higher than in trabeculectomy group (WMD = 1.90, 95%CI: 0.12-3.69), P < 0.05). The canaloplasty group showed higher success rate than trabeculectomy group (RR = 0.86, 95%CI: 0.77-0.97). The canaloplasty group was more likely to have hyphema (RR = 2.96, 95%CI: 1.51-5.83), P < 0.05) than trabeculectomy group (RR = 0.24, 95, CI(0.06-0.89), P < 0.05]. The incidence of and hypotony and postoperative choroid abnormalities in canaloplasty group was significantly lower than that in trabeculectomy group (RR = 0.30, 95%CI: 0.11-0.83; RR = 0.24, 95%CI: 0.09-0.66), P < 0.05). Both trabeculectomy and canaloplasty can significantly reduce the intraocular pressure in glaucoma patients at 12 months after operation, trabeculectomy leads a more marked IOP decrease than canaloplasty at the cost of a higher complication rate and more demanding for postoperative care.

SUBMITTER: Liu H

PROVIDER: S-EPMC5546520 | biostudies-literature | 2017 Jul

REPOSITORIES: biostudies-literature

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Safety and efficacy of canaloplasty versus trabeculectomy in treatment of glaucoma.

Liu Haifeng H Zhang Haitao H Li Yanhua Y Yu Han H

Oncotarget 20170701 27

We assess the efficacy and safety of canaloplasty and trabeculectomy for treatment of glaucoma. We searched the China National Knowledge Infrastructure, PubMed, Web of Science, and WanFang databases for potentially eligible studies. Pooled risk ratio (RR) with 95% confidence interval (CI) was calculated using random- or fixed-effect models if appropriate. Eight studies were included for meta-analysis. There was no difference in intraocular pressure at 6 months (WMD = 0.97, 95%CI: -0.48-2.41). In ...[more]

PMID: 28118610

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Project description:IntroductionTo investigate the outcomes of trabeculectomy (TRAB) versus repeat Ahmed glaucoma valve (re-AGV) implantation in eyes with Ahmed glaucoma valve (AGV) failure.MethodsThis quasi-experimental study includes patients with failed AGV implants requiring additional surgical intervention between 2018 and 2022. Patients in the TRAB group underwent a fornix-based procedure with mitomycin C 0.01% injection (0.1 mL). Eyes in the re-AGV group underwent repeat shunt surgery. The choice of the procedure was based on conjunctival condition. The primary outcome measure was surgical success rate based on various intraocular pressure (IOP) targets and percentages of IOP reduction from baseline: IOP ≤ 21 mmHg and 20% reduction (conventional criteria), IOP ≤ 18 and > 20% reduction (criterion A), IOP ≤ 15 and > 25% reduction (criterion B), and IOP ≤ 12 and > 30% reduction (criterion C).ResultsForty-eight eyes of 48 patients were operated and reported herein, consisting of 22 eyes of 22 patients undergoing TRAB and 26 eyes of 26 subjects undergoing re-AGV. No significant difference was observed between the study groups in terms of initial diagnoses, baseline IOP or the number of prior surgeries. The cumulative probability of survival at one year was significantly higher in the trabeculectomy group using the three stricter success definitions. In both study groups, IOP was significantly reduced from baseline at all postoperative visits, and was significantly lower in the TRAB group at all time points beyond one month. At 12 months, 5% of TRAB versus 48% of re-AGV eyes required glaucoma medications (P < 0.001). The rate of complications was comparable between the study groups (P = 0.76) but there was a trend toward a greater need for repeat surgery in the re-AGV group (4 eyes versus nil, P = 0.07).ConclusionsTrabeculectomy can be considered a safe and effective surgical option in eyes with failed AGV leading to significantly lower IOP levels and more favorable success rates than re-AGV in selected patients.

Project description:PurposeTo describe the incidence and outcomes of reoperations for glaucoma in the Tube Versus Trabeculectomy (TVT) Study.DesignCohort study of patients in a multicenter randomized clinical trial.MethodsThe TVT Study enrolled 212 patients with medically uncontrolled glaucoma who had previous cataract and/or glaucoma surgery. Randomization assigned 107 patients to surgery with a tube shunt (350 mm(2) Baerveldt glaucoma implant) and 105 patients to trabeculectomy with mitomycin C (0.4 mg/mL for 4 minutes). Data were analyzed from patients who failed their assigned treatment and had additional glaucoma surgery. Outcome measures included intraocular pressure (IOP), use of glaucoma medications, visual acuity, surgical complications, and failure (IOP >21 mm Hg or not reduced by 20%, IOP ≤5 mm Hg, additional glaucoma surgery, or loss of light perception vision).ResultsAdditional glaucoma surgery was performed in 8 patients in the tube group and 18 patients in the trabeculectomy group in the TVT Study, and the 5-year cumulative reoperation rate was 9% in the tube group and 29% in the trabeculectomy group (P = .025). Follow-up (mean ± SD) after additional glaucoma surgery was 28.0 ± 16.0 months in the tube group and 30.5 ± 20.4 months in the trabeculectomy group (P = .76). At 2 years after a glaucoma reoperation, IOP (mean ± SD) was 15.0 ± 5.5 mm Hg in the tube group and 14.4 ± 6.6 mm Hg in the trabeculectomy group (P = .84). The number of glaucoma medications (mean ± SD) after 2 years of follow-up was 1.1 ± 1.3 in the tube group and 1.4 ± 1.4 in the trabeculectomy group (P = .71). The cumulative probability of failure at 1, 2, 3, and 4 years after additional glaucoma surgery was 0%, 43%, 43%, and 43%, respectively, in the tube group, and 0%, 9%, 20%, and 47% in the trabeculectomy group (P = .28). Reoperations to manage complications were required in 1 patient in the tube group and 5 patients in the trabeculectomy group (P = .63).ConclusionsThe rate of reoperation for glaucoma was higher following trabeculectomy with mitomycin C than tube shunt surgery in the TVT Study. Similar surgical outcomes were observed after additional glaucoma surgery, irrespective of initial randomized treatment in the study.

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Safety and efficacy of canaloplasty versus trabeculectomy in treatment of glaucoma.

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Safety and efficacy of canaloplasty versus trabeculectomy in treatment of glaucoma.

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