Ab-Externo MicroShunt versus Trabeculectomy in Primary Open-Angle Glaucoma: One-Year Results from a 2-Year...

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Clinical Trials

Background:

• Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness.
• Effective IOP reduction is crucial for managing POAG progression.
• Surgical interventions like MicroShunt and trabeculectomy are used when medical therapy fails.

Purpose of the Study:

• To compare the one-year effectiveness and safety of MicroShunt implantation versus trabeculectomy in POAG patients.
• To evaluate surgical success rates, intraocular pressure (IOP) reduction, and adverse events between the two surgical methods.

Main Methods:

• A prospective, randomized, multicenter, noninferiority study involving 527 patients with POAG.
• Patients were randomized 3:1 to receive either MicroShunt or trabeculectomy, both with adjunctive mitomycin C.
• Primary endpoint was surgical success defined as ≥20% IOP reduction at 1 year without increased medication.

Main Results:

• Trabeculectomy showed a higher probability of success (72.7%) compared to MicroShunt (53.9%) at year 1 (P < 0.01).
• Mean IOP reduction was greater with trabeculectomy (-45.4%) than MicroShunt (-29.1%), with fewer medications required in the trabeculectomy group.
• While transient hypotony was more common with trabeculectomy, vision-threatening complications were rare in both groups.

Conclusions:

• MicroShunt implantation resulted in a lower probability of surgical success compared to trabeculectomy in POAG patients.
• Trabeculectomy achieved superior IOP reduction and required fewer medications at the one-year follow-up.
• Both procedures demonstrated acceptable safety profiles, though specific adverse events differed between the groups.