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Published on: December 9, 2022
Intermediate Outcomes of Styrene-Block-Isobutylene-Block-Styrene Microshunt, Gelatin Microstent, and Trabeculectomy:
Moncef Berkache1, Rayan Tolba2, Kenan Bachour1
1Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada.
Purpose:
To compare the 2-year surgical success rates, the complications, and risk factors for failure of the styrene-block-isobutylene-block-styrene (SIBS) microshunt, the gelatin microstent, and trabeculectomy.
Design:
Single-center, single-surgeon retrospective cohort study.
Subjects:
142 eyes from 124 adult patients diagnosed with glaucoma (43 SIBS microshunt, 63 gelatin microstent, and 36 trabeculectomy).
Methods:
Consecutive eyes that underwent SIBS microshunt implantation, gelatin microstent implantation, and trabeculectomy were compared.
Main Outcome Measures:
The primary outcome was the proportion of eyes achieving surgical success at 2 years, defined as (1) intraocular pressure (IOP) between 6 and 17 mmHg (inclusive) without the number of glaucoma medication classes (meds) (complete success) or with meds (qualified success); (2) no IOP readings >17 mmHg or <6 mmHg with clinical hypotony, on 2 consecutive visits; and (3) no surgical revision, reoperation, or loss of light perception. Secondary outcomes included success rates for IOP range of 6 to 14 and 6 to 21 mmHg, postoperative IOP, meds, complications, additional interventions, and risk factors for failure.
Results:
SIBS microshunt group included a significantly higher proportion of eyes with prior failed glaucoma filtering surgery (41.9% vs. 0% for gelatin microstent and 2.8% for trabeculectomy, respectively; P < 0.001). At 24 months, complete success rates in the 6 to 17 mmHg range were 72.1% for SIBS microshunt, compared with 50.0% for trabeculectomy (P = 0.034) and 38.1% for gelatin microstent (P < 0.0001). Qualified success was achieved in 83.7%, 66.7%, and 55.6%, respectively, with SIBS demonstrating superior outcomes to gelatin microstent (P = 0.003). In the multivariable analysis, the gelatin microstent (hazard ratio [HR]: 3.43; 95% confidence interval [CI]: 1.61-7.31) and combined cataract surgery (HR: 2.06; 95% CI: 1.27-3.35) were associated with increased hazard of failure, while age ≥70 years was associated with lower risk of failure (HR: 0.54; 95% CI: 0.30‑0.98). All procedures significantly reduced IOP and meds (P < 0.001). Complication rates were similar across groups, most resolving before 3 months. Needling was performed in 2.3% (SIBS microshunt), 30.2% (gelatin microstent), and 30.6% (trabeculectomy) of eyes, and 5-fluorouracil injections in 48.8%, 25.4%, and 50.0%, respectively. Revision rates were 4.7%, 7.9%, and 0%, respectively (P = 0.283), while reoperations were higher with gelatin microstent (15.9% vs. 2.3% and 2.8%; P = 0.022).
Conclusions:
Despite higher-risk baseline profile, the SIBS microshunt achieved higher 2-year success rates than trabeculectomy and gelatin microstent across multiple IOP ranges, with comparable complications and fewer reoperations.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
