A-stream glaucoma shunt versus trabeculectomy: 1-year results on efficacy and safety

To compare surgical efficacy and safety of trabeculectomy (TRAB) and a minimally invasive bleb device called A-stream Glaucoma Shunt, that features an intraluminal ripcord for adjustable flow resistance. Retrospective multicenter study. A total of 68 eyes (30 A-stream, 38 TRAB) with at least 12 months of follow-up. Primary open-angle, pigmentary, or pseudoexfoliation glaucoma with uncontrolled IOP despite maximal medical therapy were included. surgical success at 1 year (IOP ≤ 18 mmHg and ≥ 20% reduction from baseline, with or without medication). At 1 year, Complete and qualified success rates were 56.7% and 80.0% for A-stream and 44.7% and 65.8% for TRAB (p > 0.05). Mean IOP decreased from 24.5 ± 5.5 to 11.4 ± 1.8 mmHg in the A-stream group and from 25.7 ± 4.6 to 11.3 ± 3.3 mmHg in the TRAB group. The mean number of glaucoma medications decreased from 3.7 ± 0.8 to 0.4 ± 0.9 (A-stream) and from 3.8 ± 0.5 to 0.6 ± 1.0 (TRAB). Clinically significant hypotony occurred only in TRAB. The A-stream Glaucoma Shunt achieved IOP and medication reduction comparable to trabeculectomy with fewer hypotony-related complications.