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Angle Closure Glaucoma: Treatment01:28

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Angle-closure glaucoma, or closed-angle glaucoma, is an eye condition where the iris bulges out and blocks the iridocorneal angle, resulting in a buildup of aqueous humor and increased intraocular pressure. Immediate medical attention is necessary due to the sudden onset of symptoms. The treatment for angle-closure glaucoma includes short-term and long-term approaches. Short-term treatment involves using eye drops like pilocarpine to lower intraocular pressure by increasing aqueous humor...
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Ab-Externo MicroShunt versus Trabeculectomy in Primary Open-Angle Glaucoma: Two-Year Results from a Randomized,

Joseph F Panarelli1, Marlene R Moster2, Julian Garcia-Feijoo3

  • 1New York University, New York, New York.

Ophthalmology
|September 28, 2023
PubMed
Summary

Trabeculectomy demonstrated greater surgical success than the MicroShunt in reducing intraocular pressure (IOP) for primary open-angle glaucoma (POAG) patients over two years. Both procedures effectively lowered IOP and medication needs, with trabeculectomy showing a higher success rate.

Keywords:
Antifibrotic agentsAqueous drainage devicesMinimally invasive glaucoma surgeryOpen-angle glaucomaTrabeculectomy

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Area of Science:

  • Ophthalmology
  • Glaucoma Surgery
  • Medical Devices

Background:

  • Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness worldwide.
  • Effective management of POAG often requires surgical intervention to lower intraocular pressure (IOP).
  • The MicroShunt and trabeculectomy are surgical options for POAG, each with distinct mechanisms and outcomes.

Purpose of the Study:

  • To compare the effectiveness and safety of the MicroShunt versus trabeculectomy in patients with POAG.
  • Evaluate surgical success rates, IOP reduction, and medication use.
  • Assess the incidence of adverse events and postoperative interventions for both procedures.

Main Methods:

  • A prospective, randomized, multicenter trial was conducted in the US and Europe.
  • Adult patients (40-85 years) with POAG inadequately controlled by medication were randomized 3:1 to MicroShunt (n=395) or trabeculectomy (n=132).
  • Both procedures were augmented with mitomycin C (MMC), and surgical success was defined as a ≥20% reduction in diurnal IOP without increased medication.

Main Results:

  • At 2 years, trabeculectomy achieved a higher surgical success rate (64.4%) compared to the MicroShunt (50.6%) (P=0.005).
  • Both groups showed significant IOP reduction and decreased medication use from baseline (P<0.001).
  • Hypotony was more frequent after trabeculectomy (51.1%) than MicroShunt (30.9%) (P<0.001), while MicroShunt required repositioning/explantation in 6.8% of cases.

Conclusions:

  • Both MicroShunt and trabeculectomy are effective in reducing IOP and medication use in POAG patients.
  • Trabeculectomy demonstrated superior surgical success rates at the two-year follow-up.
  • While both procedures have associated risks, trabeculectomy had a higher incidence of hypotony, and the MicroShunt had a higher rate of device-related interventions.