CO2 laser-assisted sclerectomy vs trabeculectomy: one-year results

Session Details

Session Title: Microinvasive Glaucoma Surgery

Session Date/Time: Sunday 15/09/2019 | 14:00-16:00

Paper Time: 15:48

Venue: Free Paper Forum: Podium 4

First Author: : J.Simão PORTUGAL

Co Author(s): :    J. Chaves   M. Raimundo   J. Cardoso   P. Faria   J. Filipe   J. Pereira              

Abstract Details

Purpose:

This study aimed to compare the efficacy and safety of glaucoma surgery using CO2 LASER-assisted sclerectomy surgery (CLASS) and Cairns trabeculectomy (TRAB) in primary open-angle glaucoma (POAG) and pseudoexfoliative (PEX) glaucoma .

Setting:

Tertiary referral-center (Centro Hospitalar e Universitário da Universidade de Coimbra, Coimbra, Portugal).

Methods:

Retrospective case series including patients with POAG and PEX glaucoma that underwent filtration surgery (TRAB or CLASS). Exclusion criteria included simultaneous phacoemulsification with TRAB or CLASS. Best corrected visual acuity (BCVA), intraocular pressure (IOP) and number of antiglaucoma medications were documented at baseline and at all postoperative clinic visits with main outcomes evaluated at 12 months post-operatively. All intra- and postoperative complications were registered. Complete success was defined as an IOP < 21 mmHg, with no medications or reoperations. Qualified success was defined as IOP < 21 mmHg with medications and/or reoperations.

Results:

Seventy-two eyes (POAG 65%, PEX 35%) were submitted to CLASS (n=29) or TRAB (n=43). Mean baseline IOP was 24.08±5.28 mmHg. At month 12, observed BCVA loss was -0,11±0.23 (p=0.552). IOP reduction with CLASS was -7.04±5.45, comparing to -10.75 ±5.86 with TRAB (p=0.017). Complete success occurred in 53.66% and 31.82% of cases in TRAB and CLASS (p=0.097), respectively. Qualified success occurred in 97.56% and 90.91% in TRAB and CLASS (p=0.237), respectively. Need of reoperation (including needling) was 25% in CLASS versus 23.26% in TRAB (p=0.866). Complications (major and minor) were greater in Trab 27.9% vs CLASS 6.9% (p0.004).

Conclusions:

We present a study comparing glaucoma CO2 LASER-assisted sclerectomy vs. trabeculectomy and its visual and IOP related outcomes evaluated one year after surgery. While the CLASS procedure has an overall lower IOP reduction effect than trabeculectomy, it is associated with a significantly lower incidence of complications and a very high qualified success percentage.

Financial Disclosure:

None