Purchase this article with an account.
Taylor Jones, Sandra Johnson; Comparison of tube implants versus trabeculectomy surgery outcomes among Medicare beneficiaries in the treatment of glaucoma. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4962.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
The methods of glaucoma surgery have not been compared much among Medicare-aged patients alone. This study evaluates the outcomes of the Ahmed tube shunt, the Baerveldt tube shunt, the Express Glaucoma Shunt, and trabeculectomy surgery in Medicare beneficiaries.
We analyzed medical records for patients ages 65 and older who received glaucoma surgery between January 2010 and May 2016 at the University of Virginia to determine the short-term outcomes in patients receiving each type of surgery. Intraocular pressure (IOP) and number of medications were recorded at 3 months post-operation to include major complications (choroidals and choroidal hemorrhages) which often occur by then.
523 eyes were enrolled (83 Express shunts, 251 trabeculectomies, 89 Ahmed shunts, and 100 Baerveldt shunts). For open angle patients, the average 3-month IOP was 11 in the Express group, 11 in the trabeculectomy group, 16 in the Ahmed group, and 14 in the Baerveldt group. In closed angle patients, the average 3-month IOP was 20 in the Express group, 13 in the trabeculectomy group, 18 in the Ahmed group, and 11 in the Baerveldt group. Complications were most frequent in the trabeculectomy group, with 10 patients presenting with complications within the post-operative period. 5 Baerveldt and 4 Ahmed patients had post-op complications. None were noted for the Express shunt patients. For open angle patients, the average number of glaucoma medications was 0.10 for the Express group, 0.32 for the trabeculectomy group, 1.15 for the Ahmed group, and 1.08 for the Baerveldt group. In patients with closed angle glaucoma, the average number of medications was 0.50 for Express and Baerveldt patients, 0.47 for trabeculectomy patients and 1.00 for Ahmed patients.
In open angle glaucoma patients, Express shunts achieved the lowest IOP and number of medications at 3 months post-op. In the closed angle group, Baerveldt patients had the lowest 3-month IOP; however, the trabeculectomy patients took the fewest medications at 3 months. Express shunt patients also had the fewest short-term complications across both glaucoma types. Though this review may offer insight into safety and efficacy of glaucoma surgical procedures for Medicare-aged patients, it also shows varied sample sizes for each surgery (with the more traditional procedures used more frequently) and a short-term focus.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
This PDF is available to Subscribers Only