Longer-term Baerveldt to Trabectome glaucoma surgery comparison using propensity score matching

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Medical Devices

Background:

• Glaucoma drainage implants (GDIs) like the Baerveldt glaucoma drainage implant (BGI) are established treatments for severe glaucoma.
• Trabectome-mediated ab interno trabeculectomy (AIT) is an emerging minimally invasive glaucoma surgery (MIGS) showing promise for moderate to severe cases.
• Direct comparison of AIT and BGI outcomes is crucial for surgical decision-making.

Purpose of the Study:

• To compare the efficacy of Baerveldt glaucoma drainage implant (BGI) versus Trabectome-mediated ab interno trabeculectomy (AIT) in glaucoma patients.
• To evaluate intraocular pressure (IOP) reduction, medication usage, and success rates between BGI and AIT.
• To assess if AIT can achieve comparable results to BGI, traditionally used for more advanced glaucoma.

Main Methods:

• Propensity score matching was used to create comparable groups of BGI and AIT patients with at least one year of follow-up.
• Primary outcomes included intraocular pressure (IOP), number of glaucoma medications, and a Glaucoma Index (GI) score.
• Exclusion criteria included neovascular glaucoma, prior glaucoma surgery, and lack of a close match.

Main Results:

• Thirty AIT patients were matched with 29 BGI patients; baseline characteristics were similar.
• Mean IOP was comparable at 30 months (15.0 mmHg for both AIT and BGI, p > 0.05).
• AIT showed a significant reduction in medication use (p=0.001) compared to BGI (p=0.17), with fewer medications needed overall (1.5 vs 2.4, p=0.007).

Conclusions:

• Propensity score matching indicates similar IOP reduction between AIT and BGI up to one year post-surgery.
• Trabectome-mediated ab interno trabeculectomy (AIT) demonstrates a significant advantage in reducing the need for glaucoma medications.
• AIT may be a viable alternative to BGI, potentially expanding treatment options for glaucoma management.