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Refractive Changes after Glaucoma Surgery-A Comparison between Trabeculectomy and XEN Microstent Implantation
Caroline Bormann1, Catharina Busch1, Matus Rehak2
1Department of Ophthalmology, University of Leipzig, Liebigstrasse 10-14, 04103 Leipzig, Germany.
Life (Basel, Switzerland)
|November 26, 2022
Summary
Trabeculectomy (TE) and XEN microstent implantation (XEN) effectively lower intraocular pressure (IOP) in glaucoma patients. XEN did not significantly impact visual acuity, unlike TE, suggesting surgically induced astigmatism is not the cause of vision decrease after TE.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Visual Acuity Research
Background:
- Trabeculectomy (TE) can lead to temporary or permanent decreases in best-corrected visual acuity (BCVA).
- Comparing surgical outcomes between TE and XEN microstent implantation (XEN) is crucial for glaucoma management.
- Primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEX) are common forms of glaucoma requiring surgical intervention.
Purpose of the Study:
- To compare visual acuity and refractive changes after TE versus XEN implantation in patients with POAG or PEX.
- To evaluate the impact of surgically induced astigmatism (SIA) on visual acuity outcomes.
- To assess the long-term effectiveness of TE and XEN in reducing intraocular pressure (IOP) and medication use over 24 months.
Main Methods:
- A comparative study of 149 glaucoma patients undergoing either TE or XEN implantation.
- Evaluation of intraocular pressure (IOP), IOP-lowering medication use, refraction, and BCVA at 24 months.
- Calculation and vector analysis of surgically induced astigmatism (SIA) using the Jaffe and Clayman method.
Main Results:
- Both TE and XEN significantly reduced mean IOP and medication use after 24 months (p < 0.01).
- Mean BCVA significantly decreased after TE (p < 0.01) but remained stable after XEN (p = 0.28).
- Surgically induced astigmatism (SIA) was comparable between TE (0.75 ± 0.60 D) and XEN (0.81 ± 0.56 D), with no significant correlation to BCVA changes or IOP reduction.
Conclusions:
- TE and XEN are effective for IOP reduction and decreasing medication reliance in glaucoma patients.
- XEN implantation shows a more favorable visual acuity outcome compared to TE at 24 months.
- SIA is unlikely to be the primary cause of decreased visual acuity observed after TE.
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