Five-year reoperation rates after Schlemm's canal-based glaucoma surgery versus trabeculectomy

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Surgical Outcomes

Background:

• Glaucoma management often requires surgical intervention to control intraocular pressure (IOP).
• Trabeculectomy (Trab) is a traditional glaucoma surgery, while Schlemm's canal (SC)-based procedures are newer alternatives.
• Comparing the long-term reoperation rates and risk factors is crucial for optimizing patient care.

Purpose of the Study:

• To compare the 5-year reoperation rates between SC-based glaucoma surgery and Trab.
• To identify independent risk factors associated with reoperations after these glaucoma surgeries.

Main Methods:

• Retrospective case series analysis of patients undergoing glaucoma surgery between 2017 and 2021.
• Propensity score matching to ensure comparable groups for SC-based surgery and Trab.
• Kaplan-Meier survival analysis and Cox regression models to assess reoperation rates and risk factors.

Main Results:

• SC-based glaucoma surgery demonstrated a significantly lower 5-year cumulative reoperation rate (11.9%) compared to Trab (15.4%).
• Uncontrolled intraocular pressure (IOP) was the primary reason for reoperations in both surgical groups.
• Trab surgery, elevated preoperative IOP, increased use of preoperative medications, and prior glaucoma surgery history were identified as independent risk factors for reoperation.

Conclusions:

• SC-based glaucoma surgery offers a potentially more favorable long-term safety profile with lower reoperation rates than Trab.
• Identifying risk factors such as high preoperative IOP and prior surgical history can aid in patient selection and postoperative management strategies.
• These findings support considering SC-based procedures for patients requiring glaucoma surgery to potentially reduce the need for subsequent interventions.