AI Article Synopsis
- The study compares tube shunt surgery and trabeculectomy with mitomycin C in treating angle-closure glaucoma, involving 80 patients who underwent these procedures.
- Trab-MMC showed significantly higher complete success rates compared to Tube, particularly at one and two years post-surgery, though the qualified success rates were similar for both methods.
- Both methods effectively reduced intraocular pressure and medication use over two years, with Trab-MMC patients generally needing fewer medications during the first year but similar requirements by the second year.
Article Abstract
Purpose: Compare outcomes of tube shunt surgery (Tube) and trabeculectomy with mitomycin C (Trab-MMC) in patients with angle-closure glaucoma (ACG).
Design: Retrospective nonrandomized comparative study.
Participants: A total of 80 eyes from 80 patients with ACG who underwent either Tube (N = 50) or Trab-MMC (N = 30) between January 2015 and January 2022 at Massachusetts Eye and Ear.
Methods: Reviewed and analyzed 390 visits from patient charts.
Main Outcome Measures: Kaplan-Meier (KM) success rates, intraocular pressure (IOP), medication burden, best-corrected visual acuity (BCVA), adjusted hazard ratios (HRs), and complications.
Results: Baseline demographics were similar between both groups, except for a higher proportion of patients with pseudophakia and prior incisional ocular surgery in the Tube group. The Trab-MMC procedure had significantly higher KM complete success (CS) rates than the Tube procedure, but similar qualified success (QS) rates. Under QS, the cumulative probability of survival was 87% in the Tube group and 83% in the Trab-MMC group at year 1 (P = 0.77), and 75% in the Tube group and 58% in the Trab-MMC group at year 2 (P = 0.14). Under CS, the cumulative probability of survival was 13% in the Tube group and 59% in the Trab-MMC group at year 1 (P < 0.001), and 11% in the Tube group and 41% in the Trab-MMC group at year 2 (P < 0.001). Both Tube and Trab-MMC procedures resulted in significant patterns of IOP and medication reduction from baseline up to 2 years with mean IOP reduced to 12.6 ± 5.9 mmHg on 2.8 ± 1.4 medications after Tube and 12.1 ± 6.6 mmHg on 2.4 ± 1.7 medications after Trab-MMC. Patients who underwent Trab-MMC required less IOP-lowering medications at every follow-up visit up to year 1, but a similar number at year 2. No significant differences were found in IOP reduction, BCVA, or complication rates between groups.
Conclusions: We demonstrate that Trab-MMC confers similar IOP reduction and QS rates to Tube placement in patients with ACG. Trab-MMC, however, demonstrated greater medication burden reduction up to 1 year, and more favorable CS rates up to 2 years, while still maintaining similar complication rates to Tube.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Source |
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| http://dx.doi.org/10.1016/j.ogla.2024.04.005 | DOI Listing |
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