Comparison of six-month outcomes of trabeculectomy, XEN and iStent performed by a single surgeon

Session Details

Session Title: Microinvasive Glaucoma Surgery

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

Paper Time: 14:18

Venue: Free Paper Forum: Podium 4

First Author: : J.Van Der Hoek UK

Co Author(s): :                                 

Abstract Details

Purpose:

This paper compares medium range outcomes of three common glaucoma procedures, including two of the MIGS. Pre and post-operative IOP is compared as well as success and qualified success rates, rates of intervention such as needling and 5FU injections in the 6 month post-operative period. The purpose of this review is to identify the most suitable glaucoma procedure for patient groups with diverse needs

Setting:

A small district hospital in the north of the UK with a busy glaucoma practice

Methods:

Consecutive glaucoma procedures (trabeculectomy, Xen and iStent) between 1 January 2016 and 1 November 2018 were reviewed retrospectively and outcomes at 6 months compared. All but one trabeculectomy were performed without phaco, 58 (74%) of Xen implants were combined with phaco as were 31 (86%) of iStent implantations. All operations were performed by one surgeon, the patients were reviewed in clinic by departmental staff. Narrow-angle indications were excluded. Success was defined as IOP less than 22 mmHg and at least 20% IOP-reduction, qualified success was similar with the use of medication.

Results:

147 cases were reviewed after 15 exclusions (25 trabs, 84 xens, 36 iStents); Mean age: Trabeculectomy 67.5 (32-86), Xen 76.4 (57-92), iStent 77.2 (53-92); Mean pre-operative IOP: Trabeculectomy 25.1 (range 16-40), Xen 24.6 (13-48), iStent 23.5(15-30). Mean IOP at month 6: Trabeculectomy (n=18) 13.6 (6-20), Xen (n=77) 16.4 (7-30), iStent (n=10) 18 (15-23). Median IOP reductions (1st and 3rd quartiles): Trabeculectomy 11(7-17), Xen 8.5(2.75-11), iStent 6.5(4-9.5). Success and qualified outcomes (Kaplan-Meier): Trabeculectomy 0.86/ 1.0; Xen 0.59 / 0.87; iStent nil/ 0.78. ; Use of medication: Trabeculectomy 11%, Xen 39%, iStent 100%. Interventions: Trabeculectomy 0%, Xen 39.4%, iStent 0%

Conclusions:

Trabeculectomy remains the most effective operation to control IOP compared to two common MIGS procedures. Mean pre-op IOP in the trabeculectomy group is higher whilst post-operative IOP is lower and reduction in IOP greater. Most of the MIGS were combined with phaco which may have influenced outcomes, but comparison of phaco and non phaco MIGS do not reveal significant differences. Xen has the highest requirement of post-operative interventions and consequently is no longer used in this unit. iStents is a reasonable option for cataract patients needing modest IOP reduction accepting the need to continue their usual medication

Financial Disclosure:

None