Comparison of a second-generation trabecular bypass (iStent inject) to ab interno trabeculectomy (Trabectome) by exact m
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GLAUCOMA
Comparison of a second-generation trabecular bypass (iStent inject) to ab interno trabeculectomy (Trabectome) by exact matching Yousef Al Yousef 1 & Alicja Strzalkowska 1 & Jost Hillenkamp 1 & André Rosentreter 2 & Nils A. Loewen 1 Received: 1 December 2019 / Revised: 7 September 2020 / Accepted: 10 September 2020 # The Author(s) 2020
Abstract Purpose To achieve a highly balanced comparison of trabecular bypass stenting (IS2, iStent inject) with ab interno trabeculectomy (T, Trabectome) by exact matching. Methods Fifty-three IS2 eyes were matched to 3446 T eyes. Patients were matched using exact matching by baseline intraocular pressure (IOP), the number of glaucoma medications, and glaucoma type, and using nearest neighbor matching by age. Individuals without a close match were excluded. All surgeries were combined with phacoemulsification. Results A total of 78 eyes (39 in each group) could be matched as exact pairs with a baseline IOP of 18.3 ± 5.1 mmHg and glaucoma medications of 2.7 ± 1.2 in each. IOP in IS2 was reduced to 14.6 ± 4.2 mmHg at 3 months and in T to a minimum of 13.1 ± 3.2 mmHg at 1 month. In IS2, IOP began to rise again at 6 months, eventually exceeding baseline. At 24 months, IOP in IS2 was 18.8 ± 9.0 mmHg and in T 14.2 ± 3.5 mmHg. IS2 had a higher average IOP than T at all postoperative visits (p < 0.05 at 1, 12, 18 months). Glaucoma medications decreased to 2.0 ± 1.5 in IS2 and to 1.5 ± 1.4 in T. Conclusion T resulted in a larger and sustained IOP reduction compared with IS2 where a rebound occurred after 6 months to slightly above preoperative values.
Key messages Both trabecular bypass stents and trabecular ablation are microincisional glaucoma surgeries that improve conventional outflow. Implanted stents can suffer from biofilm deposition and fibrosis around six months. Exact matching of iStent inject to Trabectome patients in this study revealed a loss of effect in iStent patients at six months. The two surgeries had an equally good safety profile.
Keywords Glaucoma surgery . iStent . Trabecular bypass stent . Trabectome . Ab interno trabeculectomy . Exact matching
Introduction Following reports of fibrosis [1] and biofilm deposition [2] after trabecular bypass device implantation, we recently used exact * Nils A. Loewen [email protected] 1
Department of Ophthalmology, University of Würzburg, Josef-Schneider-Straße, 11 97080 Würzburg, Germany
2
Department of Ophthalmology, University Witten/Herdecke, Wuppertal, Germany
matching to compare a first-generation trabecular bypass stent (IS1, iStent, Glaukos Corp., San Clemente, CA) to trabecular ablation (T, Trabectome, MicroSurgical Technology, Redmond, WA) [3]. Many surgeons now use microincisional glaucoma surgeries (MIGS) first before considering more extensive, traditional procedures (trabeculectomy, tube shunt) because they have a lower complication rate [4] and shorter procedure time, which allows them to be combined with outpatient cataract surgery. In eyes with stents, we found evidence of declining function in th
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