Hamed Esfandiari1, Kenneth Taubenslag1, Priyal Shah1, Swati Goyal2, Adam J Weiner3, Melissa L Severson4, Asher Weiner4, Davinder S Grover5, Igor I Bussel1, Nils A Loewen6. 1. Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pennsylvania, USA. 2. Eye Q Superspeciality Eye Hospital, Gurgaon, India. 3. Beaumont Eye Institute, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA. 4. Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York, USA. 5. Glaucoma Associates of Texas, Dallas, USA. 6. Department of Ophthalmology, University of Würzburg, Würzburg, Germany. Electronic address: loewen.nils@gmail.com.
Abstract
PURPOSE: To create a balanced comparison of ab interno trabeculectomy (AIT) (Trabectome) and trabecular bypass stenting (TBS) (iStent). SETTING: Eye and Ear Institute, Pittsburgh, Pennsylvania, Ross Eye Institute, Buffalo, New York, and Glaucoma Associates of Texas, Dallas, USA. DESIGN: Retrospective case series. METHODS: The primary outcome measure was an unmedicated intraocular pressure (IOP) of 21 mm Hg or less and the secondary measure was an unmedicated IOP reduction of 20% or more at 2 years. Patients were matched by baseline IOP, number of glaucoma medications, and glaucoma type using exact matching and by age using nearest neighbor matching. Individuals without a close match were excluded. All surgeries were combined with phacoemulsification. RESULTS: One hundred fifty-four AIT eyes and 110 TBS eyes were analyzed. Forty-eight AIT patients were exactly matched with 48 TBS patients. Both groups had a mean baseline IOP of 15.3 mm Hg ± 3.1 (SD). At 24 months, the mean IOP was 13.9 ± 3.3 mm Hg in AIT patients and 16.8 ± 2.8 mm Hg in TBS patients and the mean number of medications was 0.7 ± 1.0 and 1.7 ± 1.2, respectively (both P = .04). At 24 months, the IOP was 21 mm Hg or less without medications in 53% of AIT patients and 16.6% of TBS patients (P < .05). At that time, 17.6% of patients in the AIT group but no patient in the TBS group had an IOP reduction of 20% or more without medication. CONCLUSION: An exact matching comparison of AIT and TBS showed greater IOP reduction with fewer medications after AIT.
PURPOSE: To create a balanced comparison of ab interno trabeculectomy (AIT) (Trabectome) and trabecular bypass stenting (TBS) (iStent). SETTING: Eye and Ear Institute, Pittsburgh, Pennsylvania, Ross Eye Institute, Buffalo, New York, and Glaucoma Associates of Texas, Dallas, USA. DESIGN: Retrospective case series. METHODS: The primary outcome measure was an unmedicated intraocular pressure (IOP) of 21 mm Hg or less and the secondary measure was an unmedicated IOP reduction of 20% or more at 2 years. Patients were matched by baseline IOP, number of glaucoma medications, and glaucoma type using exact matching and by age using nearest neighbor matching. Individuals without a close match were excluded. All surgeries were combined with phacoemulsification. RESULTS: One hundred fifty-four AIT eyes and 110 TBS eyes were analyzed. Forty-eight AIT patients were exactly matched with 48 TBS patients. Both groups had a mean baseline IOP of 15.3 mm Hg ± 3.1 (SD). At 24 months, the mean IOP was 13.9 ± 3.3 mm Hg in AIT patients and 16.8 ± 2.8 mm Hg in TBS patients and the mean number of medications was 0.7 ± 1.0 and 1.7 ± 1.2, respectively (both P = .04). At 24 months, the IOP was 21 mm Hg or less without medications in 53% of AIT patients and 16.6% of TBS patients (P < .05). At that time, 17.6% of patients in the AIT group but no patient in the TBS group had an IOP reduction of 20% or more without medication. CONCLUSION: An exact matching comparison of AIT and TBS showed greater IOP reduction with fewer medications after AIT.
Authors: Ralitsa T Loewen; Susannah Waxman; Chao Wang; Sarah Atta; Si Chen; Simon C Watkins; Alan M Watson; Nils A Loewen Journal: PLoS One Date: 2020-05-18 Impact factor: 3.240
Authors: A Strzalkowska; P Strzalkowski; Y Al Yousef; F Grehn; J Hillenkamp; Nils A Loewen Journal: Graefes Arch Clin Exp Ophthalmol Date: 2020-12-02 Impact factor: 3.117