Comparison of a second-generation trabecular bypass (iStent inject) to ab interno trabeculectomy (Trabectome) by exact matching

Yousef, Yousef Al; Strzalkowska, Alicja; Hillenkamp, Jost; Rosentreter, André; Loewen, Nils A.

doi:10.1007/s00417-020-04933-z

Cited by 12 publications

(12 citation statements)

References 43 publications

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“…Several studies have reported greater postoperative IOP reductions of excisional goniotomy performed using the Kahook Dual Blade (KDB) (New World Medical, Rancho Cucamonga, CA, USA) compared with the iStent [ 19 , 20 , 21 ]. Other studies have shown similar or slightly larger IOP reductions with ab-interno goniotomy performed with the Trabectome (NeoMedix, Tustin, CA, USA) than with the iStent [ 22 , 23 , 24 , 25 ]. The surgical efficacy of µLOT has been comparable to the KDB [ 26 , 27 , 28 ] and ab externo LOT [ 29 ] in multiple studies, although one study reported less chance of achieving surgical success with µLOT than with the Trabectome [ 30 ].…”

Section: Discussionmentioning

confidence: 88%

Fellow-Eye Comparison between Phaco-Microhook Ab-Interno Trabeculotomy and Phaco-iStent Trabecular Micro-Bypass Stent

Takayanagi

Ichioka

Ishida

et al. 2021

JCM

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The aim of this study is to compare the surgical efficacy and safety between microhook ab-interno trabeculotomy (µLOT) and iStent trabecular micro-bypass stent implantation when both were combined with cataract surgery in both eyes of patients. Sixty-four glaucomatous eyes (32 participants; mean age, 75.9 ± 7.6 years; 15 men, 17 women) were included retrospectively. Intraocular pressure (IOP), number of antiglaucoma medications, best-corrected visual acuity (BCVA), anterior chamber flare (ACF) and corneal endothelial cell density (CECD) were evaluated preoperatively, as well as 2, 3, 6, and 12 months postoperatively. Surgical complications and interventions were compared between the procedures. The preoperative IOP and medications with µLOT (18.8 ± 5.7 mmHg and 3.0 ± 1.2, respectively) were higher than with the iStent (15.5 ± 3.4 mmHg and 2.7 ± 1.2, respectively) (p = 0.0001 and p = 0.0437, respectively). At 12 months, the µLOT values (12.6 ± 2.3 mmHg and 2.3 ± 0.9, respectively) were identical to iStent (12.8 ± 2.5 mmHg and 2.3 ± 0.9, respectively) (p = 0.0934 and p = 0.3251, respectively). At 12 months, the IOP decreased more with µLOT (6.2 mmHg, 29.5%) than iStent (2.7 mmHg, 15.6%) (p = 0.0003). The decrease in medications was greater with µLOT (0.7) than iStent (0.4) (p = 0.0437). Survival rate of IOP control ≤15 mmHg and IOP reduction ≥20% was significantly higher after µLOT (40.6% at 12 months) than iStent (18.8%) (p = 0.0277). The frequency of layered hyphema was significantly greater with µLOT (8 eyes, 25%) than iStent (0 eyes, 0%) (p = 0.0048). The increase in the ACF at 2 weeks postoperatively was significantly greater with µLOT than iStent (p = 0.0156), while changes in the BCVA and CECD were identical between groups. The fellow-eye comparison showed that the IOP reduction was greater with µLOT than iStent when combined with cataract surgery.

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Section: Discussionmentioning

confidence: 88%

Fellow-Eye Comparison between Phaco-Microhook Ab-Interno Trabeculotomy and Phaco-iStent Trabecular Micro-Bypass Stent

Takayanagi

Ichioka

Ishida

et al. 2021

JCM

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“…One study found that in eyes with all stages and types of glaucoma, phaco/Trabectome lowered IOP by 22.7%, which was sustained for 2 years, while the IOP reduction from iStent inject with cataract surgery (phaco/iStent inject) began to wear off at 6 months and became non-significant at 2 years. 15 Despite phaco/Trabectome's IOP-lowering effect, the mean medication reduction between phaco/Trabectome and phaco/ iStent inject was not statistically different. 15 The most frequent complication of Trabectome was bleeding in the form of hyphema (23%-48%), microhyphema (27%-77%), delayed-onset hyphema (5%), and intraoperative blood reflux (59%-100%).…”

Section: Trabectome ®mentioning

confidence: 83%

Microinvasive Glaucoma Surgery: An Evidence-Based Review

Birnbaum

Neeson

Valle

2021

Seminars in Ophthalmology

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Purpose: Interest in micro-invasive glaucoma surgery (MIGS) has exploded over the last 8 years with an increase in MIGS procedures of at least 400% in the United States, according to Medicare data. MIGS is an umbrella term that can cover many different types of surgeries. This review focuses on peer-reviewed evidence for Trabectome ® , iStent inject ® , Kahook Dual Blade ® , XEN ® Gel Stent, and Hydrus ® . Methods: We present key recent studies evaluating the efficacy and safety of MIGS in various types of glaucoma patients with different stages of disease. Conclusion: We conclude that MIGS is generally safe and efficacious, although only some MIGS have been studied through randomized clinical trials. When comparing and contrasting the different MIGS procedures, large prospective studies are not yet the norm. High-quality large prospective studies involving MIGS will be an important next step as ophthalmologists decide how to incorporate MIGS into their surgical armamentarium.

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“…Matching is a nonparametric method designed to control confounding [35]. Propensity score matching would be well suited to compare such dissimilar datasets [36,37], while exact matching is more commonly used to compare similar data [23,38]. However, exact matching allowed us in this study to more carefully examine two of the most important variables in glaucoma care, IOP, and eye drops needed to achieve this IOP.…”

Section: Discussionmentioning

confidence: 99%

Exact matching of trabectome-mediated ab interno trabeculectomy to conventional trabeculectomy with mitomycin C followed for 2 years

Strzalkowska

Strzalkowski

Yousef

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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Purpose We used exact matching for a highly balanced comparison of ab interno trabeculectomy (AIT) with the trabectome to trabeculectomy with mitomycin C (TRAB). Methods A total of 5485 patients who underwent AIT were exact-matched to 196 TRAB patients by baseline intraocular pressure (IOP), number of glaucoma medications, and glaucoma type. Nearest-neighbor–matching was applied to age. Success was defined as a final IOP of less than 21 mmHg, IOP reduction of at least 20% reduction from baseline, and no secondary surgical interventions. Outcomes were measured at 1, 3, 6, 12, 18, and 24 months. Results A total of 165 AIT could be matched to 165 TRAB. The mean baseline IOP was 22.3 ± 5.6 mmHg, and the baseline number of glaucoma medications was 2.7 ± 1.1 in both groups. At 24 months, IOP was reduced to 15.8 ± 5.2 mmHg in AIT and 12.4 ± 4.7 mmHg in TRAB. IOP was lower than baseline at all visits (p < 0.01) and lower in TRAB than AIT (p < 0.01). Glaucoma medications were reduced to 2.1 ± 1.3 in AIT and 0.2 ± 0.8 in TRAB. Compared to baseline, patients used fewer drops postoperatively (p < 0.01) and more infrequently in TRAB than in AIT (p > 0.01). Secondary surgical interventions had the highest impact on success and became necessary in 15 AIT and 59 TRAB patients. Thirty-two challenging events occurred in TRAB and none in AIT. Conclusion Both AIT and TRAB reduced IOP and medications. This reduction was more significant in TRAB but at the expense of four times as many secondary interventions.

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Comparison of a second-generation trabecular bypass (iStent inject) to ab interno trabeculectomy (Trabectome) by exact matching

Cited by 12 publications

References 43 publications

Fellow-Eye Comparison between Phaco-Microhook Ab-Interno Trabeculotomy and Phaco-iStent Trabecular Micro-Bypass Stent

Fellow-Eye Comparison between Phaco-Microhook Ab-Interno Trabeculotomy and Phaco-iStent Trabecular Micro-Bypass Stent

Microinvasive Glaucoma Surgery: An Evidence-Based Review

Exact matching of trabectome-mediated ab interno trabeculectomy to conventional trabeculectomy with mitomycin C followed for 2 years

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