Trabecular microbypass as replacement therapy in pharmacologically controlled open-angle glaucoma patients

Area of Science:

• Ophthalmology
• Glaucoma Research
• Surgical Interventions

Background:

• Open-angle glaucoma (OAG) management often involves medication, but treatment efficacy can vary.
• Trabecular bypass surgery presents an alternative or adjunctive therapy to reduce intraocular pressure (IOP).
• Assessing outcomes based on baseline IOP control is crucial for surgical success prediction.

Purpose of the Study:

• To evaluate the effectiveness of trabecular bypass surgery as a replacement for medications in OAG patients.
• To compare outcomes between patients with pharmacologically controlled IOP below 18 mmHg versus those at or above 18 mmHg.
• To determine success rates, medication reduction, and medication-free status post-surgery.

Main Methods:

• Retrospective analysis of patients undergoing first- or second-generation trabecular bypass (iStent/iStent inject).
• Group 1: Eyes with baseline IOP <18 mmHg; Group 2: Eyes with baseline IOP ≥18 mmHg.
• Key outcomes included qualified (with/without meds) and complete (medication-free) success rates at various IOP targets, medication reduction, and proportion of medication-free eyes.

Main Results:

• Both groups demonstrated high qualified success rates for IOP control.
• Complete success rates were significantly higher in Group 1 (IOP <18 mmHg) compared to Group 2 (IOP ≥18 mmHg) across all IOP targets.
• A greater proportion of eyes in Group 1 became medication-free (79.0% vs. 47.7%) with a higher mean reduction in medication use.

Conclusions:

• Trabecular bypass surgery is effective in both pharmacologically controlled and uncontrolled OAG patients.
• Eyes with baseline IOP <18 mmHg exhibit superior complete success rates and a higher likelihood of achieving medication independence after trabecular bypass.
• Surgical outcomes are influenced by baseline IOP, highlighting the importance of patient selection for maximizing medication-free success.