Trabeculectomy remains the most effective and safe treatment for open-angle glaucoma. Microinvasive bypass surgery can be used as a second-line method.
Researchers from New York University, Wills Eye Hospital and UCL Eye Institute in London compared the effectiveness and safety of microshunt implantation and trabeculectomy in patients with primary open-angle glaucoma. The study results were published in the journal Ophthalmology.
At two years, the surgical success rate was lower in the microbypass group than in the trabeculectomy group (50.6 vs. 64.4%). In the second group, there was a greater decrease in average daily intraocular pressure (by 3 mmHg).
The average number of glaucoma medications used in the two years after the intervention decreased from 3.1 to 0.9 in the MicroShunt group and from 2.9 to 0.4 in the trabeculectomy group.
The incidence of adverse outcomes was comparable in both groups, with the exception of a higher incidence of hypotension in the trabeculectomy group (51.1 vs. 30.9%). However, in the MicroShunt group, 6.8% of patients required reoperation for implant reduction or explantation. However, in most of these patients the implant was removed during subsequent glaucoma surgery.
Data from 527 adult patients with mild to severe primary open-angle glaucoma were analyzed. Participants had poorly controlled intraocular pressure (15–40 mm Hg) while receiving maximum tolerated drug therapy.
Patients were randomized in a 3:1 ratio into two groups: isolated MicroShunt implantation and trabeculectomy, respectively. In both groups, mitomycin C was additionally administered at a dose of 0.2 mg/ml over two minutes. Two years after the intervention, the rate of successful surgical treatment (a decrease in average daily intraocular pressure by 20% or more compared to baseline without increasing the dose of glaucoma medications) was assessed, as well as the rate of complications and the need for postoperative interventions.
The authors believe that trabeculectomy remains the gold standard treatment for glaucoma and recommend the use of microinvasive shunt surgery as a second-line option.