Abstract
Purpose :
While it is expected that trabeculectomy would result in higher surgical success as a standalone procedure when compared to minimally invasive glaucoma surgery (MIGS), we hypothesize the additional fibrosis and higher failure rates of trabeculectomy in eyes undergoing concurrent cataract surgery (CS) may result in similar success to eyes undergoing cataract MIGS procedures. This study compares 1-year outcomes of Hydrus shunt with CS to trabeculectomy with CS among individuals with primary open-angle glaucoma (POAG).
Methods :
A retrospective, comparative study was performed among patients with POAG and cataract undergoing trabeculectomy with CS or Hydrus with CS. Eyes were matched using coarsened exact matching based on pre-operative (pre-op) glaucoma severity, intraocular pressure (IOP), medication number, and IOP control (defined as achieving a pre-op clinician-set target IOP). The primary outcomes were 1) qualified success: achieving pre-op target IOP with fewer medications than in the pre-op period, and 2) complete success: achieving target IOP with zero glaucoma medications. Eyes were considered failures if they required reoperation. Survival times were compared using Kaplan-Meier and Cox proportional hazards models adjusting for inter-eye correlation.
Results :
We matched 51 eyes that received trabeculectomy to 51 eyes that received a Hydrus stent, totaling 102 eyes from 89 patients. The mean baseline IOP was 14.7 mmHg in both groups. At 1 year, eyes receiving trabeculectomy were more likely to have achieved complete success (RR = 2.04, 95% CI = 1.02-4.17, p<0.05). Qualified success, IOP, and number of glaucoma medications used after 1 year were not significantly different between groups. Eyes that received trabeculectomy were more likely to experience adverse events including hypotony, corneal edema and ptosis, and to have more visits in the 3 month post-op period compared to Hydrus eyes (5.9 vs 4.9 visits, p<0.05).
Conclusions :
CS+Hydrus and CS+trabeculectomy achieved similar rates of achieving target IOP in the absence of surgical failure. CS+Trabeculectomy was statistically better at achieving drop-free IOP lowering and may be preferable for patients who desire to be completely drop-free. However, CS+Trabeculectomy may increase the number of post-operative complications and visits compared to CS+Hydrus.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.