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Surgeon Experience as a Risk Factor for Short-Term Failure for Ab Interno Gelatin Microstent: A Canadian Multicenter

Matthew B Schlenker1, Jeb Alden Ong1, Pearson Wu1

  • 1Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Prism Eye Institute, Mississauga, Canada.

Ophthalmology. Glaucoma
|June 5, 2021
PubMed
Summary

Early ab interno gelatin microstent placement showed slightly higher reoperation rates and no significant difference in complications compared to later placement. Success outcomes may improve with surgeon experience.

Keywords:
Ab interno microstentLearning curveMIGSXen

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Area of Science:

  • Ophthalmology
  • Glaucoma Surgery
  • Medical Devices

Background:

  • Ab interno gelatin microstent implantation is a surgical option for glaucoma management.
  • Understanding the learning curve for new surgical techniques is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To compare the efficacy and safety of early versus later ab interno gelatin microstent placement with mitomycin C.

Main Methods:

  • Retrospective, propensity score-matched cohort study involving 270 eyes from 6 surgeons across 4 Canadian sites.
  • Early cases (first 20 patients per surgeon) were matched 1:1 with later cases (21+ patients).
  • Outcomes assessed included intraocular pressure (IOP) control, needling, complications, and reoperations.

Main Results:

  • Hazard ratios for failure (IOP > 17 mmHg without medication) were 1.38 (6-17 mmHg) and 1.48 (6-21 mmHg) for early versus later cases, suggesting potentially lower success in early cases.
  • Needling rates (43.0% vs 41.5%) and complication rates (9.6% vs 11.1%) were similar between groups.
  • Reoperation rates were higher in the early cases group (14.8%) compared to the later cases group (8.1%).

Conclusions:

  • The study provides some evidence for improved success with later ab interno gelatin microstent placement.
  • Early adoption by surgeons is feasible, with potential for improved outcomes as experience grows.
  • Similar needling and complication rates suggest a manageable safety profile during the learning curve.