Microstent may be good alternative to trabeculectomy
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NASHVILLE, Tenn. — Stand-alone microstent implantation and trabeculectomy are both effective at treating glaucoma, with the microstent possibly providing an alternative to trabeculectomy, according to a study presented here.
At the America Glaucoma Society meeting, Ana Isabel Martinho Miguel, MD, PhD, said minimally invasive glaucoma surgery has become an important alternative option to the gold standard treatment of trabeculectomy, which can have complications. However, the number of MIGS options can make it hard to choose the right one.
“We need studies to compare directly some of these techniques to ascertain this difference,” she said.
Researchers compared an ab interno gelatin microstent (171 eyes) against trabeculectomy (83 eyes) in patients with open-angle or combined mechanism glaucoma. The primary outcome was failure of trabeculectomy relative to the microstent over 3 years. Complete success was defined as IOP between 6 mm Hg and 17 mm Hg plus a 20% IOP reduction.
After 3 years, investigators found a similar failure rate between the groups. The survival rate was 45.3% in microstent eyes and 39.8% in trabeculectomy eyes, with a median IOP reduction of 8 mm Hg and 12 mm Hg, respectively.
In the microstent group, 48.5% of eyes underwent postoperative intervention compared with 62.7% of eyes in the trabeculectomy group. After 1 month, eyes in the trabeculectomy group had a higher rate of complications (51.8%) compared with the microstent group (31.6%) (P = .002); however, the difference was not statistically significant after the first month.
Miguel said both the microstent and trabeculectomy are good options for the treatment of glaucoma.
“Probably both have indications in glaucoma surgery,” she said. “The question is, which one do you choose?”
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Cao J, et al. Three-year efficacy and safety of standalone ab-interno gelatin microstent versus trabeculectomy. Presented at: American Glaucoma Society meeting; March 3-6, 2022; Nashville, Tennessee.
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