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Editors Selection IGR 24-3
Surgical Treatment: Ab-externo Microshunt vs. Trabeculectomy
Comment by Kin Sheng Lim & Bhavin Patel on:
112812 Ab-Externo MicroShunt versus Trabeculectomy in Primary Open-Angle Glaucoma: Two-Year Results from a Randomized, Multicenter Study, Panarelli JF; Moster MR; Garcia-Feijoo J et al., Ophthalmology, 2023; 0:
See also comment(s) by Kaweh Mansouri •Panarelli et al. present a comprehensive comparison of the safety and effectiveness of the Microshunt PreserFlo (n = 395) and trabeculectomy (n = 132) in managing primary open-angle glaucoma (POAG). The study, a prospective, randomized, multicenter trial, involves adult patients inadequately controlled on maximum tolerated medical therapy. The primary endpoint was surgical success defined by a reduction in intraocular pressure (IOP) without an increase in medications, while secondary endpoints included changes in mean IOP, medication use, and the need for postoperative interventions.
The results indicate that while both procedures significantly reduce IOP and medication dependence, trabeculectomy exhibits a higher success rate (64.4%) compared to the Microshunt (50.6%) at two years post-operation. The mean diurnal IOP reduction was more substantial in the trabeculectomy group (from 21.1 mmHg to 10.7 mmHg) compared to the Microshunt group (from 21.1 mmHg to 13.9 mmHg). Despite the lower success rate, the Microshunt showed a more favorable safety profile with fewer incidences of hypotony compared to trabeculectomy (30.9% vs. 51.1%).
The research findings underscore important discoveries, yet also recognize limitations, such as variations in surgical success rates among different regions, possibly influenced by racial and demographic factors. The authors propose that increasing the concentration of mitomycin C could enhance the effectiveness of the Microshunt, supported by previous studies.
The authors propose that increasing the concentration of mitomycin C could enhance the effectiveness of the Microshunt, supported by previous studies
In general, the study offers valuable insights on the comparative efficacy and safety of both surgical approaches for primary open-angle glaucoma (POAG). The thorough analysis and solid data bolster the conclusions, a commendable aspect. Nevertheless, further investigation is necessary to refine the Microshunt techniques for better outcomes. However, the lack of FDA approval for mitomycin-C concentrations above 0.2 mg/mL in glaucoma filtration surgery poses a significant obstacle to verifying this hypothesis.
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