Two-Year Outcome of Surgery in Glaucoma Patients

Abstract

Purpose To evaluate the 2-year surgical treatment outcome in glaucoma patients.

Methods A retrospective, single-center, interventional study was performed on 160 eyes of 125 patients suffering glaucoma, including POAG (82 eyes), pseudoexfoliation (PEX) (59 eyes), pigment dispersion (8 eyes), and secondary glaucoma (2 eyes). Eyes with uncontrolled intraocular pressure (IOP) or signs of glaucoma progression despite medical treatment were included to undergo either trabeculectomy (TE), XEN implantation, combined TE with phacoemulsification (TE + IOL), or XEN implantation with phacoemulsification surgery (XEN + IOL). Primary efficacy outcome was the mean IOP reduction. Secondary outcome was the mean reduction in the number of medications. The data were compared at baseline vs.1 day, 1 week, and 1, 3, 6, 12, and 24 months following surgery. For statistical evaluation, ANOVA-based linear mixed-effects models were performed with SPSS.

Results The mean IOP reduction in a 2-year follow-up was 30.31% (22.17 vs. 15.45 mmHg, p < 0.001). The mean number of antiglaucoma medications was reduced from 2.87 to 0.58 (p = 0.001), where TE alone or combined surgeries seemed to be more effective than isolated XEN surgery. Transient IOP hypotony on the first postoperative day occurred in PEX patients following TE surgery (p = 0.024). At 6 months, PEX patients with isolated XEN surgery showed a transient IOP increase, whereas those after combined TE + IOL surgery showed the lowest IOP within the PEX group compared to other glaucoma patients (p < 0.026).

Conclusions After 2 years, all performed glaucoma surgeries achieved a significant reduction in IOP and the number of antiglaucoma medications.

Zusammenfassung

Absicht Evaluierung des Outcomes in den ersten 2 Jahren nach Chirurgie bei Glaukompatienten.

Methoden Eine retrospektive, Single-Center-Studie wurde bei 160 Augen von 125 Glaukompatienten durchgeführt, miteingeschlossen: POWG (82 Augen), PEX (59 Augen), Pigmentdispersion (8 Augen) und Sekundärglaukom (2 Augen). Augen mit dekompensiertem Intraokulardruck (IOD) oder Zeichen einer Glaukomprogression trotz medikamentöser Therapie wurden eingeschlossen, um sich einer Trabekulektomie (TE), XEN-Implantation, kombinierter TE mit Phakoemulsifikation (Phaco-TE) oder XEN-Implantation mit Phakoemulsifikation (Phaco-XEN) zu unterziehen. Der primäre Wirksamkeitsendpunkt war die mittlere Reduktion des IODs. Sekundär wurde das Outcome der Reduktion der Anzahl Medikamentenwirkstoffe überprüft. Die Daten wurden verglichen zwischen präoperativen Werten und 1. Tag, 1. Woche, 1., 3., 6., 12. und 24. Monat postoperativ nach Glaukomchirurgie. Für die statistische Evaluation wurden ANOVA-basierte lineare, gemischte Modelle verwendet, erzeugt mit SPSS.

Resultate Die mittlere IOD-Reduktion nach 2 Jahren war 30,31% (22,17 zu 15,45 mmHg, p < 0,001). Die mittlere Anzahl der antiglaukomatösen Medikamente wurde von 2,87 auf 0,58 (p = 0,001) reduziert, wobei die TE und Phaco-TE einen Trend zur besseren Effektivität als die isolierte XEN-Implantation zeigen. Transiente IOD-Hypotonie am 1. postoperativen Tag traten bei PEX-Patienten nach TE-Chirurgie auf (p = 0,024). Nach 6 Monaten zeigten PEX-Patienten nach isolierter XEN-Implantation einen transienten IOD-Anstieg, wogegen jene nach Phaco-TE den niedrigsten IOD sowohl in der PEX-Gruppe als auch verglichen mit anderen Glaukompatienten zeigten (p < 0,026).

Schlussfolgerungen Nach 2 Jahren zeigte sich in allen durchgeführten glaukomchirurgischen Eingriffen eine signifikante Reduktion des IODs und der Reduktion der Anzahl Glaukommedikamente.

Key words

glaucoma - surgery - minimally invasive glaucoma surgery - trabeculectomy - XEN

Schlüsselwörter

Glaukom - Chirurgie - minimalinvasive Glaukomchirurgie - Trabekulektomie - XEN

Publication History

Received: 10 October 2021

Accepted: 06 February 2022

Article published online:
23 March 2022

• References

• 1 Resnikoff S, Pascolini D, Etyaʼale D. et al. Global data on visual impairment in the year 2002. Community Eye Health 2004; 17: 61
• 2 Tham YC, Li X, Wong TY. et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology 2014; 121: 2081-2090
• 3 Lichter PR, Musch DC, Gillespie BW. et al. CIGTS Study Group Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery. Ophthalmology 2001; 108: 1943-1953
• 4 Feiner L, Piltz-Seymour JR. Collaborative Initial Glaucoma Treatment Study. Collaborative Initial Glaucoma Treatment Study: A summary of results to date. Curr Opin Ophthalmol 2003; 14: 06-11
• 5 Reitsamer H, Sng C, Vera V. et al. Two-year results of a multicenter study of the ab interno gelatin implant in medically uncontrolled primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 2019; 257: 983-996
• 6 Sheybani A, Reitsamer H, Ahmed II. Fluid Dynamics of a Novel Micro-Fistula Implant for the Surgical Treatment of Glaucoma. Invest Ophthalmol Vis Sci 2015; 56: 4789-4795
• 7 Gedde SJ, Heuer DK, Parrish RK. Tube Versus Trabeculectomy Study Group: Review of results from the Tube Versus Trabeculectomy Study. Curr Opin Ophthalmol 2010; 21: 123-128
• 8 Birnbaum FA, Neeson C, Solá-Del Valle D. Microinvasive Glaucoma Surgery: An Evidence-Based Review. Semin Ophthalmol 2021; 36: 772-786
• 9 Sadruddin O, Pinchuk L, Angeles R. et al. Ab externo implantation of the MicroShunt, a poly (styrene-block-isobutylene-block-styrene) surgical device for the treatment of primary open-angle glaucoma: a review. Eye Vis (Lond) 2019; 6: 36
• 10 Manasses DT, Au L. The New Era of Glaucoma Micro-stent Surgery. Ophthalmol Ther 2016; 5: 135-146
• 11 Sheheitli H, Tirpack AR, Parrish RK. Which Patients Would Most Likely to Benefit: MIGS or MEGS, Which One Is It?. Asia Pac J Ophthalmol (Phila) 2019; 8: 436-440
• 12 Grover DS, Flynn WJ, Bashford KP. et al. Performance and safety of a new ab interno gelatin stent in refractory glaucoma at 12 months. Am J Ophthalmol 2017; 183: 25-36
• 13 Wanichwecharungruang B, Ratprasatporn N. 24-month outcomes of XEN45 gel implant versus trabeculectomy in primary glaucoma. PLoS One 2021; 16: e0256362
• 14 Schlenker MB, Ong JA, Wu P. et al. Surgeon Experience as a Risk Factor for Short-Term Failure for Ab Interno Gelatin Microstent: A Canadian Multicenter Propensity-Matched Study. Ophthalmol Glaucoma 2022; 5: 67-76
• 15 Lenzhofer M, Kersten-Gomez I, Sheybani A. et al. Four-year results of a minimally invasive transscleral glaucoma gel stent implantation in a prospective multi-centre study. Clin Exp Ophthalmol 2019; 47: 581-587
• 16 Lavin-Dapena C, Cordero-Ros R, DʼAnna O. et al. XEN 63 gel stent device in glaucoma surgery: A 5-years follow-up prospective study. Eur J Ophthalmol 2021; 31: 1829-1835
• 17 Rauchegger T, Angermann R, Willeit P. et al. Two-year outcomes of minimally invasive XEN Gel Stent implantation in primary open-angle and pseudoexfoliation glaucoma. Acta Ophthalmol 2021; 99: 369-375
• 18 Schargus M, Theilig T, Rehak M. et al. Outcome of a single XEN microstent implant for glaucoma patients with different types of glaucoma. BMC Ophthalmol 2020; 20: 490
• 19 Topouzis F, Wilson MR, Harris A. et al. Risk factors for primary open-angle glaucoma and pseudoexfoliative glaucoma in the Thessaloniki eye study. Am J Ophthalmol 2011; 152: 219-228.e1
• 20 Schlötzer-Schrehardt U. [New pathogenetic insights into pseudoexfoliation syndrome/glaucoma. Therapeutically relevant?]. Ophthalmologe 2012; 109: 944-951
• 21 Friedman DS, Jampel HD, Lubomski LH. et al. Surgical strategies for coexisting glaucoma and cataract: an evidence-based update. Ophthalmology 2002; 109: 1902-1913
• 22 Ahmadzadeh A, Kessel L, Subhi Y. et al. Comparative Efficacy of Phacotrabeculectomy versus Trabeculectomy with or without Later Phacoemulsification: A Systematic Review with Meta-Analyses. J Ophthalmol 2021; 2021: 6682534
• 23 Hengerer FH, Kohnen T, Mueller M. et al. Ab interno gel implant for the treatment of glaucoma patients with or without prior glaucoma surgery: 1-year results. J Glaucoma 2017; 26: 1130-1136
• 24 Tan SZ, Walkden A, Au L. One-year result of XEN45 implant for glaucoma: efficacy, safety, and postoperative management. Eye (Lond) 2018; 32: 324-332
• 25 Ibáñez-Muñoz A, Soto-Biforcos VS, Chacón-González M. et al. One-year follow-up of the XEN^® implant with mitomycin-C in pseudoexfoliative glaucoma patients. Eur J Ophthalmol 2019; 29: 309-314
• 26 Schlenker MB, Gulamhusein H. Conrad-Hengerer. et al. Efficacy, Safety, and Risk Factors for Failure of Standalone Ab Interno Gelatin Microstent Implantation versus Standalone Trabeculectomy. Ophthalmology 2017; 124: 1579-1588