Estimation of risk–benefit ratio and comparison of post-operative efficacy results between trabeculectomy and canaloplasty

Abstract

Purpose: To estimate a risk–benefit ratio by comparing the efficacy of canaloplasty to trabeculectomy exclusively in pseudophakic eyes with primary open angle glaucoma. Patients and methods: One hundred four eyes that underwent ab externo canaloplasty and 136 eyes that underwent trabeculectomy with mitomycin C 0.02% and collagen matrix implantation were retrospectively compared. The efficacy was evaluated by evaluating the absolute success rate (5 ⩽ intraocular pressure ⩽ 15 mmHg) and the qualified success rate (intraocular pressure ⩽15 mmHg) using the Kaplan–Meier survival analysis. A meta-analysis to evaluate the relative risk of both procedures in relation to post-operative interventions was performed. Results: Mean intraocular pressure was significantly lower in both groups. Intraocular pressure decreased by 32.17% in the canaloplasty group and by 55.04% in the trabeculectomy group at 12 months (analysis of variance, p < 0.001). Medication use was lower in both groups (analysis of variance, p < 0.001) by the 12th month. The absolute success rate for canaloplasty was 20.19% of eyes compared to 52.21% of eyes with trabeculectomy ( p < 0.0001). The qualified success rate was not statistically different between groups ( p = 0.15). The relative risk ratio was not statistically different between groups (relative risk of 0.01 and weight of 49.65% for group A and relative risk of 0.0005 and weight of 50.35% for group B; p = 0.5). The hospitalization length was longer in trabeculectomy-treated patients ( t-test, p < 0.0001). Conclusion: The trabeculectomy group showed better results in terms of absolute success rate. However, canaloplasty may provide a better risk–benefit ratio in terms of qualified success rate, hospitalization time, and required post-operative interventions, since canaloplasty yielded equal or superior results compared to trabeculectomy.

Modified suture-assisted canaloplasty in Asians with primary open-angle glaucoma: a prospective study with 12-month follow-up

“…Vastardis reported that complete and qualified success rates were 74.31% and 90% with an IOP ≤ 21 mmHg [ 27 ]. Furthermore, Vastardis reported an absolute success rate of 20.19% in advanced POAG [ 28 ]. The reason for the low success rate could be the definition of the success rate (5 ≤ IOP ≤ 15 mmHg), which was lower than usual criteria (IOP ≤ 21 mmHg or IOP ≤ 18 mmHg).…”

The Efficacy and Safety of Canaloplasty Vs Trabeculectomy Either Standalone or Combined with Cataract Surgery: An Updated Meta-Analysis

“…The results of risk of bias using the ROBINS-1 tool are illustrated in (Supplementary Table S2). Overall, one study had low risk of bias 21 , three studies had serious risk of bias 14,16,28 , and nine studies had moderate risk of bias 12,13,22,[24][25][26][27]29,30 . Bias was more frequently encountered in the "measurement of outcome" domain 12,13,16,[24][25][26]30 .…”

“…Overall, one study had low risk of bias 21 , three studies had serious risk of bias 14,16,28 , and nine studies had moderate risk of bias 12,13,22,[24][25][26][27]29,30 . Bias was more frequently encountered in the "measurement of outcome" domain 12,13,16,[24][25][26]30 . In the single randomized controlled trial, it was given an overall high risk of bias, which was driven solely due to high risk of randomization bias [due to no information regarding allocation concealment besides the presence of baseline imbalance between both interventions in terms of affected eye, IOP, and gender] 23 .…”

Trabeculectomy: Does It Have a Future?

“…Early trabeculectomy filtering procedures were associated with a high rate of complications like hypotony, hypotonic maculopathy, choroidal detachment, suprachoroidal hemorrhage, bleb-related infections, and endophthalmitis [12][13][14][15][16][17][18]. Early cases of bleb leaks, shallow anterior chamber, and hypotony can be resolved with the use of large bandage contact lenses, pressure patching, symblepharon rings, and the Simmons shell.…”

“…Early cases of bleb leaks, shallow anterior chamber, and hypotony can be resolved with the use of large bandage contact lenses, pressure patching, symblepharon rings, and the Simmons shell. However, a flat anterior chamber with lens-corneal touch requires immediate surgical intervention to prevent rapid cataract development and irreversible corneal endothelial damage [12][13][14]. Initial studies have reported hypotony and choroidal detachment as late as 2-26 months following primary uncomplicated surgery that warrants a repeat surgery [14,15].…”