MicroShunt versus Trabeculectomy for Surgical Management of Glaucoma: A Retrospective Analysis

Abstract

This case-control study aims to compare the efficacy, safety, and postoperative burden of MicroShunt versus trabeculectomy. The first consecutive cohort of MicroShunt procedures (n = 101) was matched to recent historical trabeculectomy procedures (n = 101) at two London hospital trusts. Primary endpoints included changes in intraocular pressure (IOP) and glaucoma medications. Secondary outcome measures included changes in retinal nerve fibre layer (RNFL) thickness, rates of complications, further theatre interventions, and the number of postoperative visits. From the baseline to Month-18, the median [interquartile range] IOP decreased from 22 [17–29] mmHg (on 4 [3–4] medications) to 15 [10–17] mmHg (on 0 [0–2] medications) and from 20 [16–28] mmHg (on 4 [3–4] medications) to 11 [10–13] mmHg (on 0 [0–0] medications) in the MicroShunt and trabeculectomy groups, respectively. IOP from Month-3 was significantly higher in the MicroShunt group (p = 0.006), with an increased number of medications from Month-12 (p = 0.024). There were greater RNFL thicknesses from Month-6 in the MicroShunt group (p = 0.005). The rates of complications were similar (p = 0.060) but with fewer interventions (p = 0.031) and postoperative visits (p = 0.001) in the MicroShunt group. Therefore, MicroShunt has inferior efficacy to trabeculectomy in lowering IOP and medications but provides a better safety profile and postoperative burden and may delay RNFL loss.

Comparing the safety and efficacy of Preserflo Microshunt implantation and trabeculectomy for glaucoma: A systematic review and meta‐analysis

“…11 articles were identified as eligible for a full‐text assessment. The final number of studies included in this systematic review and meta‐analysis was seven articles (Baker et al., 2021; Fili et al., 2022; Fu et al., 2022; Jamke et al., 2023; Nobl et al., 2023; Van Lancker et al., 2023; Wagner et al., 2022). A flow diagram of the screening process is depicted in Figure 1.…”

“…The mean follow‐up across all studies was 12.8 months. One study had an randomised controlled trial (RCT) design (Baker et al., 2021), two cohort designs (Jamke et al., 2023; Van Lancker et al., 2023), two case controls (Fu et al., 2022; Wagner et al., 2022) and the others had a retrospective/prospective comparative design (Fili et al., 2022; Nobl et al., 2023). The main characteristics and complications of the included studies can be found in Tables S1–S3.…”

“…Fu et al. (2022) found that the Preserflo group had significantly shorter operation times, 50 versus 71 min for trabeculectomy ( p < 0.001). Van Lancker et al.…”

Wirksamkeit, Einflussfaktoren und Sicherheit des Preserflo Microshunt

“…Zusätzlich zu den häufigsten Komplikationen führten andere Studien seltene Komplikationen auf, wie ein Makulaödem, eine hypotone Makulopathie oder eine Irisobstruktion 15 , 19 , 20 , 28 , 29 , 30 .…”

Minimally Invasive Glaucoma Surgery: Latest Developments and Future Challenges

“…and safety of PRESERFLO implantation are comparable trabeculectomy in animal studies. 162,163 Aside from a potentially better safety profile, 164,165 the results of PRESERFLO in clinical studies were variable. At the 6 months postoperative period, the prospective study by Pillunat et al 147 that included POAG and normal tension glaucoma eyes showed that PRESERFLO implantation and trabeculectomy achieved similar IOP reduction, with fewer postoperative interventions for eyes after PRESERFLO implantation.…”