Treatment Outcomes in the Primary Tube Versus Trabeculectomy Study after 1 Year of Follow-up

Shi, Wei; Lim, Kin Sheng; Barton, Keith; Goyal, Saurabh; Brandt, James D.; Gedde, Steven J.; Banitt, Michael R.; Budenz, Donald L.; Lee, Richard S.; Palmberg, Paul; Parrish, Richard K.; Porta, Luís; Wellik, Sarah R.; Werner, Mark; Zink, Jeffrey M.; Khatana, Anup K.; Grover, Davinder S.; Neelakantan, Arvind; Karmouty, Ahmed El; Puertas, Renata; Panarelli, Joseph F.; Vinod, Kateki; Lind, John T.; Shields, Steven R.; Alaghband, Pouya; Sherwood, Mark B.; Khaimi, Mahmoud A.; Sankar, Prithvi S.; Ansari, Husam; Miller-Ellis, Eydie; Feldman, Robert M.; Baker, Laura A.; Bell, Nicholas P.; Ahmed, Iqbal Ike K.; Williams, Donna; Prum, Bruce E.; Ramulu, Pradeep Y.; Jampel, Henry D.; Feuer, William J.; Londono, Luz; Schiffman, Joyce C.; Silva, Yolanda; Vanner, Elizabeth A.; Chen, Philip; Heuer, Dale K.; Singh, Kuldev; Wright, Martha M.

doi:10.1016/j.ophtha.2018.02.003

Cited by 215 publications

(124 citation statements)

References 40 publications

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“…The total rate of needling within one year after surgery was 16% in both groups. Similarly, Gedde et al described a needling rate of 14% for their trabeculectomy cohort [18]. In contrast, Mansouri et al reported a considerably higher needling rate of 45% in the…”

Section: Discussionmentioning

confidence: 95%

Efficacy and safety of XEN®—Implantation vs. trabeculectomy: Data of a “real-world” setting

et al. 2020

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ObjectiveTo compare surgical success, postoperative intraocular pressure and complication rates between trabeculectomy and XEN gelstent surgery in a cohort of glaucoma patients in a typical clinical setting. MethodsA retrospective cohort study of consecutive patients with refractory open-angle glaucoma including patients who underwent either stand-alone XEN gelstent insertion with Mitomycin C or trabeculectomy with Mitomycin C between 2016 and 2018 at the University Eye Hospital Mainz, Germany. Primary outcome measure was the proportion of surgical success 1 year after surgery. Patients with an IOP �18mmHg, an intraocular pressure reduction of >20% and in no need of revision surgery or topical medication were considered a complete surgical success. If topical therapy was necessary, they were considered a qualified success. Multivariable logistic regression analysis was carried out for the primary outcome including gender, age, preoperative intraocular pressure and number of medication classes used preoperatively as adjustment variables. Results171 eyes of 144 patients were included, including 82 eyes of 58 patients in the XEN group and 89 eyes of 86 patients in the trabeculectomy group. The primary outcome defined as the proportion of surgical success after 1 year (mean 11.1 months ± 2.2) was similar for both groups. The complete success proportion was 65.5% (95%-CI: 55.6-75.9%) in the trabeculectomy group, and 58.5% (95%-CI: 47.6-69.4%) in the XEN group and not statistically different in our analysis model (crude OR = 0.61; 95%-CI: 0.31-1.22; adjusted OR = 0.66; 95%-CI: 0.32-1.37). The intraocular pressure reduction, as secondary outcome measure, was higher in the trabeculectomy group (10.5 mmHg) compared to the XEN group (7.2 mmHg; p = 0.003) at the 12-month follow-up.Citation: Wagner FM, Schuster AK-G, Emmerich J, Chronopoulos P, Hoffmann EM (2020) Efficacy and safety of XEN®-Implantation vs. trabeculectomy: Data of a "real-world" setting. PLoS ONE 15(4): e0231614. https://doi.org/10.

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Section: Discussionmentioning

confidence: 95%

Efficacy and safety of XEN®—Implantation vs. trabeculectomy: Data of a “real-world” setting

et al. 2020

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“…The most recent example of newness outweighing data-driven change is the micropulse method of diode ciliodestruction, for which no studies have been published that compare it to standard diode application. In contrast, in an impressively designed and implemented study, trabeculectomy has been shown to have advantages over tube shunt surgery in a controlled, randomized clinical trial for eyes without past glaucoma surgery [36]. To be sure, improvements in glaucoma surgery are truly needed and the excitement in the many attempts shows this need.…”

Section: The Emperor's New Surgeriesmentioning

confidence: 99%

21st century glaucoma care

Quigley

2018

Eye

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Glaucoma care has evolved dramatically over the past generation, with changes that have incorporated new technology and improved understanding of the disease process. A major need is to construct a useful definition of glaucomatous optic neuropathy that can be used to compare data across clinical research studies. The treatment of glaucoma should now be based on achievement of a goal target for intraocular pressure, unique to each patient. Adherence with eye drop treatment is far from ideal and can be improved using reminder systems. Sustained delivery of glaucoma medication is on the horizon. New surgical approaches to glaucoma are being actively studied but have not as yet found their place in its care, with rigorous testing against present treatments needed.

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“…5 In contrast, human pericardium (Tutoplast) has a thin configuration and is not associated with postoperative inflammation, which makes it a favorable choice to cover the tube in GDD implantation. 3 The rationale for using patch graft is to protect the tube from direct eyelid repetitive trauma and broaden the elevated area to reduce the risk of tube erosion. In spite of covering the seton with patch graft, tube erosion occurs.…”

Section: Discussionmentioning

confidence: 99%

“…3 While bleb-related complications of trabeculectomy are not seen after glaucoma drainage device (GDD) implantations, 4 these devices predispose patients to certain adverse events related to the implantation of a foreign body on the surface of the eye. One unique complication is the exposure of the glaucoma drainage device.…”

Section: Introductionmentioning

confidence: 99%

Ahmed Glaucoma Valve Implantation: Graft-Free Short Tunnel Small Flap versus Scleral Patch Graft After 1 Year Follow-Up: A Randomised Clinical Trial

Pakravan¹,

Hatami²,

Esfandiari³

et al. 2018

Preprint

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Abstract:Purpose: To compare the efficacy and safety of graft-free short tunnel small flap (STSF) technique with that of scleral patch graft (SPG) in Ahmed glaucoma valve (AGV) implantation. Design: Randomized clinical trial.Participants: Eighty-eyes of eighty patients with medically uncontrolled glaucoma including 41 in STSF and 39 eyes in SPG. Methods:Patients were enrolled and assigned randomly to STSF or SPG.Main Outcome Measures: tube exposure, Intraocular pressure (IOP), number of glaucoma medications, best corrected visual acuity (BCVA), surgical complications, and success rate ( defined as intraocular pressure (IOP) >5 mmHg, ≤21 mmHg, and IOP reduction ≥20% from baseline at two consecutive visits after three months, no reoperation for glaucoma).Results: only one case in SPG developed tube exposure at 1-year follow-up. The cumulative probability of success during the first year of follow-up was 70% in the STSF and 65% in SPG (P = 0.36). IOP decreased significantly from 29.6 ± 8.6 mmHg at baseline to 16.4 ± 3.6 mmHg at the final follow-up in STSF (p = 0.001). The corresponding numbers for SPG were 30.9 ± 11.2 and 15.8 ± 4.7, respectively (p = 0.001). The final IOP was comparable between both groups (p = 0.65). Mean ± standard deviation of the number of glaucoma medications was 1.8 ± 0.9 in STSF and 1.6 ± 0.9 in SPG at final follow-up (P = 0.32). Postoperative complications developed in 8 patients (19%) in STSF and 9 patients (23%) in SPG (P = 0.81).Conclusions: STSF and SPG techniques had comparable complication rate at one-year followup. Both techniques were comparable in terms of success rate, postoperative IOP, and glaucoma medications.

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Treatment Outcomes in the Primary Tube Versus Trabeculectomy Study after 1 Year of Follow-up

Cited by 215 publications

References 40 publications

Efficacy and safety of XEN®—Implantation vs. trabeculectomy: Data of a “real-world” setting

Efficacy and safety of XEN®—Implantation vs. trabeculectomy: Data of a “real-world” setting

21st century glaucoma care

Ahmed Glaucoma Valve Implantation: Graft-Free Short Tunnel Small Flap versus Scleral Patch Graft After 1 Year Follow-Up: A Randomised Clinical Trial

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