Effectiveness of Trabeculectomy and Tube Shunt With Versus Without Concurrent Phacoemulsification: IRIS Registry Longitudinal Analysis

Citation:

Ciociola EC, Yang S-A, Hall N, Lorch AC, Miller JW, Friedman DS, Boland MV, Elze T, Zebardast N, Zebardast N. Effectiveness of Trabeculectomy and Tube Shunt With Versus Without Concurrent Phacoemulsification: IRIS Registry Longitudinal Analysis. Ophthalmol Glaucoma 2022;

Date Published:

2022 Jul 12

Abstract:

OBJECTIVE: To determine the effectiveness of trabeculectomy and glaucoma drainage device (GDD) surgery performed with concurrent phacoemulsification compared to stand-alone procedures. DESIGN: Multicenter retrospective cohort study. PARTICIPANTS: Patients in the IRIS® Registry (Intelligent Research in Sight) who underwent trabeculectomy or GDD from 2013 through 2019. METHODS: Kaplan-Meier survival analysis was used to determine reoperation rates. Reoperation was defined as any subsequent glaucoma surgery occurring 1 month to 3 years after the initial procedure. Multivariable cox proportional hazard models were used to determine reoperation risk factors. MAIN OUTCOME MEASURES: Reoperation rate, IOP, visual acuity, reoperation procedure type, postoperative complications, and predictors of surgical failure. RESULTS: A total of 117,697 eyes receiving glaucoma surgery alone and 35,657 eyes receiving surgery with phacoemulsification were included. The cumulative reoperation rate for trabeculectomy alone was 4.9% and 11.5% vs 3.0% and 7.3% for trabeculectomy combined with phacoemulsification (p<0.001) at postoperative one and three years, respectively. The reoperation rates for GDD alone were 3.8% and 7.8% vs 2.1% and 5.4% for GDD with phacoemulsification (p<0.001) at postoperative one and three years, respectively. Stand-alone procedures achieved greater IOP reduction by percentage change from baseline (trabeculectomy alone 35.3% vs trabeculectomy with phacoemulsification 23.1%, p<0.001, and GDD alone 36.1% vs GDD with phacoemulsification 29.3%, p<0.001). Visual acuity improved by 0.12 logMAR (95% CI 0.11 - 0.12) and 0.10 logMAR (0.08 - 0.11) following trabeculectomy and GDD with phacoemulsification and declined by 0.15 logMAR (0.14 - 0.15) and 0.12 logMAR (0.11 - 0.12) following stand-alone trabeculectomy and GDD. The overall documented complication rate was 2.9% for GDD and 1.4% for trabeculectomy. Age, sex, race, ethnicity, baseline IOP, and glaucoma diagnosis and severity were associated with surgical failure risk. The most common reoperation procedure was GDD. CONCLUSIONS: Reoperation rates within the first three years following trabeculectomy and GDD with and without phacoemulsification were low. Trabeculectomy and GDD with phacoemulsification had lower reoperation rates compared to stand-alone procedures. However, stand-alone procedures resulted in greater IOP reduction compared to combined procedures. Postoperative complications were uncommon overall. Patient age, sex, race, ethnicity, baseline IOP, and glaucoma diagnosis and severity were associated with surgical success.

See also: Glaucoma, July 2022, All, 2022
Last updated on 07/31/2022