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You Zhou, Bennett Y. Hong, Rahul Thakkar, Brittany Bunag, Jeffrey Mattingly, Gianmarco Vizzeri; Postoperative Year Three Outcomes of A Novel Modified Minimally Invasive Trabeculectomy: Primary Iris-Sparing Fornix-Based Microtrabeculectomy with Mitomycin C versus Primary Phacomicrotrabeculectomy. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3146.
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At ARVO 2019 the authors presented the two-year outcomes of a modified microtrabeculectomy technique in a small population (N=69) (Poster #B0083). This abstract seeks to expand on the outcome analysis with a larger sample size and longer follow-up. In addition, subgroup analysis between microtrabeculectomy cases (“trab”) and combined phacoemulsification-microtrabeculectomy cases (“phacotrab”) was performed.
This is a retrospective single surgeon case series. All trab or phacotrab cases between 1/1/2013 and 1/1/2018 were included. Patients with a history of previous incisional glaucoma surgery in the operative eye were excluded. 67 trabs (48.9%) and 70 phacotrabs (51.1%) met inclusion criteria. Baseline data is shown in Table 1. For analysis, the Student’s T-test and the Chi-Square test were used. Outcomes include intraocular pressure (IOP) and topical antihypertensive use. Surgical success is defined as IOP ≤ 21 mmHg (Criteria A) or IOP reduction ≥ 20% (Criteria B). Surgical failure is defined as inability to meet Criteria A or B, or need for subsequent glaucoma surgery in the operative eye, e.g. trab, tube shunt, etc.
In the trab group, IOP improved from 25.3 at baseline to 13.1, 13.2, and 12.9 at postop years 1, 2, and 3, (POY1,2,3) respectively. The phacotrab group performed similarly and the difference was not significant (p>0.05). Trab cases meeting Criteria A went from 82.5% (POY1) to 65.9% (POY3) and was not significantly different from phacotrab Criteria A outcomes of 90.3% (POY1) to 78.4% (POY3). Aside from POY1, there was no difference in meeting Criteria B between trabs and phacotrabs (Table 2). 19.4% of trabs required additional surgery, while 10.0% of phacotrabs did, although this was not significant (p>0.05). Topical antihypertensive use decreased from 2.72 to 1.13 (trabs) and 2.30 to 1.18 (phacotrabs) by POY3, p>0.05.
With a sample size twice that of the previous preliminary analysis this study demonstrates that this microtrabeculectomy technique can achieve good IOP control and decreased medication burden among glaucoma patients through postop year 3. Furthermore, the data shows that concomitant phacoemulsification does not negatively impact outcomes. After POY1, Criteria A and B success and average postop IOP’s were the same in both groups.
This is a 2020 ARVO Annual Meeting abstract.
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