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Comparing outcomes of trabeculectomy with mitomycin C to 45 μm gelatin stent placed ab externo with open conjunctiva.
Ophthalmology Glaucoma 2023 December 5
PURPOSE: To compare trabeculectomy with mitomycin C (trab-MMC) and XEN®45 Gel Stent placed ab externo with open conjunctiva (XGS AEO) with or without cataract surgery in patients with glaucoma.
DESIGN: Nonrandomized, retrospective comparative study.
SUBJECTS: A total of 204 eyes from 204 glaucoma patients who received XGS placed AEO or underwent trab-MMC with or without cataract surgery between July 2018 and August 2021 at Massachusetts Eye and Ear.
METHODS: Visits from 204 patients' charts were reviewed following either trab-MMC or XGS AEO from 2018-2021 from a level 3 triage center.
MAIN OUTCOME MEASURES: Intraocular pressure (IOP), medication burden, Kaplan-Meier success rates, 5-fluorouracil impact, and complications.
RESULTS: 157 patients underwent trab-MMC and 47 underwent XGS AEO. Groups had similar baseline intraocular pressure (IOP) and medications (meds). IOP and meds decreased similarly at 1.5 years (11.2 mmHg vs 7.4 mmHg, p=0.62; 2.9 vs 2.8 meds, p=0.92, respectively for trab-MMC and XGS AEO). Success was defined as IOP reduction ≥ 20% with 5 mmHg ≤ IOP ≤ 18 mmHg for 2 consecutive visits. Complete success (CS) did not allow meds; qualified success (QS) allowed for ≤ baseline meds. When IOP fluctuations in the first 60 days were not counted as failures, CS was 43% for trab-MMC, about 8.5% higher than for XGS AEO (p<0.01). QS was similar between the groups (65-67%). Procedure time was shorter for XGS AEO than trab-MMC (44 vs 63 min, p<0.01).
CONCLUSIONS: XGS AEO may provide similar benefits to trab-MMC, especially for patients who tolerate some meds, with shorter procedure times.
DESIGN: Nonrandomized, retrospective comparative study.
SUBJECTS: A total of 204 eyes from 204 glaucoma patients who received XGS placed AEO or underwent trab-MMC with or without cataract surgery between July 2018 and August 2021 at Massachusetts Eye and Ear.
METHODS: Visits from 204 patients' charts were reviewed following either trab-MMC or XGS AEO from 2018-2021 from a level 3 triage center.
MAIN OUTCOME MEASURES: Intraocular pressure (IOP), medication burden, Kaplan-Meier success rates, 5-fluorouracil impact, and complications.
RESULTS: 157 patients underwent trab-MMC and 47 underwent XGS AEO. Groups had similar baseline intraocular pressure (IOP) and medications (meds). IOP and meds decreased similarly at 1.5 years (11.2 mmHg vs 7.4 mmHg, p=0.62; 2.9 vs 2.8 meds, p=0.92, respectively for trab-MMC and XGS AEO). Success was defined as IOP reduction ≥ 20% with 5 mmHg ≤ IOP ≤ 18 mmHg for 2 consecutive visits. Complete success (CS) did not allow meds; qualified success (QS) allowed for ≤ baseline meds. When IOP fluctuations in the first 60 days were not counted as failures, CS was 43% for trab-MMC, about 8.5% higher than for XGS AEO (p<0.01). QS was similar between the groups (65-67%). Procedure time was shorter for XGS AEO than trab-MMC (44 vs 63 min, p<0.01).
CONCLUSIONS: XGS AEO may provide similar benefits to trab-MMC, especially for patients who tolerate some meds, with shorter procedure times.
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