Abstract #100657 Published in IGR 23-1

Comparing Surgical Outcomes in Neovascular Glaucoma between Tube and Trabeculectomy: A Multicenter Study

Iwasaki K; Kojima S; Wajima R; Okazaki T; Yokoyama Y; Inoue T; Higashide T; Miki A; Nakazawa T; Inatani M
Ophthalmology. Glaucoma 2022; 0:

See also comment(s) by Steve Mansberger & Alexander Robin

OBJECTIVE: To compare the surgical outcomes between Baerveldt glaucoma implant (BGI) surgery and trabeculectomy with mitomycin C for patients with neovascular glaucoma (NVG). DESIGN: Retrospective clinical cohort study at five clinical centers in Japan. PARTICIPANTS: Patients treated with trabeculectomy or BGI for NVG between April 1, 2012, and December 31, 2019, at five clinical centers were recruited. METHODS: The inclusion criteria were age ≥20 years and having NVG. The exclusion criteria were eyes with no light perception vision and with previous tube-shunt surgery. If both eyes in the same patient satisfied the inclusion criteria, the eye that was treated first was investigated. We included 100 eyes undergoing BGI surgery and 204 eyes undergoing trabeculectomy. MAIN OUTCOME MEASURES: The primary outcome was surgical success or failure, with failure being defined according to three criteria: <20% reduction of the preoperative intraocular pressure (IOP) or criterion A (IOP >21 mmHg), criterion B (IOP >17 mmHg), or criterion C (IOP >14 mmHg). Cases of reoperation, a loss of light perception vision, or hypotony were also considered failures. RESULTS: The probability of success was significantly higher in patients undergoing BGI surgery than in those receiving trabeculectomy for criteria A (P < 0.01) and B (P = 0.01). Trabeculectomy was significantly associated with surgical failure in the multivariable analysis for criterion A (hazard ratio, 1.70) and criterion B (hazard ratio, 1.50). The overall incidence of postoperative complications was similar between the two groups. Reoperations for glaucoma were required significantly more frequently in the trabeculectomy group than in the BGI surgery group (20.1 % vs. 5.0%, P < 0.01). CONCLUSIONS: BGI surgery had a higher success rate as compared with trabeculectomy in patients with NVG for a target IOP of <21 mmHg or <17 mmHg. The rates of postoperative complications were similar between both surgical procedures. Additional glaucoma surgery was required more frequently after trabeculectomy than after BGI surgery.

Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.

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