Comparison of subconjunctival microinvasive glaucoma surgery and trabeculectomy

Abstract

Purpose: To assess surgical success and the post-operative development of intraocular pressure between XEN45 â gelstent, Preserflo â MicroShunt and trabeculectomy with mitomycin C. Methods: Data from 105 eyes from 105 patients of matched cases with refractory open-angle glaucoma, who underwent surgery between January 2019, and August 2020, were evaluated. Patients underwent either stand-alone XEN gelstent insertion with Mitomycin C, stand-alone Preserflo with Mitomycin C or trabeculectomy with Mitomycin C. The primary outcome was the proportion of complete surgical success at 6 months post-operatively (i.e. intraocular pressure between 5mmHg and 18mmHg, no revision surgery, no loss of light perception and no post-operative pharmaceutical antiglaucomatous treatment). The reduction of intraocular pressure after 6 months, the classes of antiglaucomatous medication used post-operatively, best-corrected visual acuity, spherical refractive errors and astigmatism were assessed as secondary outcomes. Results: We included 35 eyes in each group. After 6-month follow-up, complete success was 73.5% [95%-CI: 57.9%-89.2%] in the trabeculectomy group, 51.4% [95%-CI: 34.0%-68.8%] in the XEN group and 74.2% [95%-CI: 57.9%-90.5%] in the Preserflo group (p = 0.08). Regarding secondary outcomes, the reduction of intraocular pressure was 12.1 AE 7.9 mmHg in the trabeculectomy group and was thereby 5.8 [95%-CI: 2.2-9.6] mmHg greater compared with the XEN group (p < 0.001) and 4.8 [95%-CI: 0.9-8.7] mmHg higher than the Preserflo group (p = 0.01). Conclusions: No statistically significant differences were found between trabeculectomy, XEN45 â gelstent implantation and Preserflo â MicroShunt implantation regarding surgical success after 6 months. Yet reduction in intraocular pressure was significantly higher in the trabeculectomy group. However, all three interventions resulted in sufficiently low post-operative intraocular pressure and may therefore be considered individually for glaucoma treatment.

Early Complications and Results of Preserflo MicroShunt in the Management of Uncontrolled Open-Angle Glaucoma: A Case Series

“…Despite the described complications, the Preserflo MicroShunt seems to be an effective surgical device for glaucoma treatment. Wagner et al reported no statistically significant differences between trabeculectomy, XEN45 gel stent, and Preserflo MicroShunt in terms of surgical success after 6 months, but the reduction in IOP was significantly greater in the trabeculectomy group [ 22 ]. Fea et al showed the IOP-lowering effect of the Preserflo MicroShunt, which reduced the need for antiglaucoma medications in patients with POAG and PXG.…”

PreserFlo® MicroShunt: An Overview of This Minimally Invasive Device for Open-Angle Glaucoma

“…Wagner et al recently conducted another comparison, which included Xen Gel Stent, PreserFlo MicroShunt and trabeculectomy with MMC in three subgroups of 35 eyes per group [ 52 ]. Complete success was 73.5 percent in the trabeculectomy group, 51.4 percent in the XEN group, and 74.2 percent in the PreserFlo group at 6-month follow-up.…”

“…Numerically speaking, the IOP decrease was of 12.1 mmHg from baseline in the trabeculectomy group, significantly higher than in the other two subgroups (5.8 mmHg higher than the XEN group and 4.8 mmHg higher than the PreserFlo group). In conclusion, all three methods resulted in a sufficiently low post-operative intraocular pressure, showing comparable surgical success after six months, and hence may be evaluated separately for glaucoma therapy [ 52 ].…”

Evaluation of a Novel Αb Εxterno MicroShunt for the Treatment of Glaucoma

“…Wagner and coworkers [16] reported a retrospective case-control 6-month study including 105 patients with refractory POAG, or exfoliative glaucoma who underwent either trabeculectomy, XEN45 gelstent insertion, or MicroShunt implant surgery all augmented with 0.2 mg/ml MMC for 3 min [16]. Of note, the trabeculectomy group (n = 35) exhibited higher baseline IOP (21.0 mmHg) and required more medications (3.0) than the XEN45 group (n = 35), or the MicroShunt group (n = 35).…”

“…For example, the surgical success criterion employed by Baker and coworkers [14] was IOP lowering of at least 20% from baseline without an increase in medical therapy. This was different from the criterion employed by Wagner and coworkers [16]. Varying definitions of success in the study protocols investigating novel IOP-lowering surgical interventions, especially MIGS, are a persistent obstacle limiting the comparability of these studies [2,3,16].…”