Trabeculectomy, although effective at lowering IOP in patients with open-angle glaucoma, has a low safety profile, according to a study by the Department of Medicine in the University of Udine in Udine, Italy.
Researchers conducted a systematic search of peer-reviewed literature until Jan. 10, 2018, using PubMed, Medline, Scopus and Embase. All studies included in this evaluation contained at least one comparison between trabeculectomy (TE) and nonpenetrating glaucoma surgery (NPGS), deep sclerectomy (DS), viscocanalostomy (VC) or canaloplasty (CP).
The primary outcome measures were the mean difference from baseline in IOP at 6, 12 and 24 months at follow-up. Complications after surgery such as hypotony, choroidal detachment or effusion, flat or shallow anterior chamber, cataract formation or progression and hyphema were analyzed.
“At least one comparison between TE and any nonpenetrating filtering procedure had to be present in the selected studies,” Andrea Gabai, MD, and colleagues wrote. “We included studies wherein surgeries could be performed with intraoperative antimetabolites and, for DS, with subscleral implants.”
In the 21 studies included in the overall evaluation, TE was found to be associated with hypotony, choroidal detachment or effusion, anterior chamber shallowing or flattening, and cataract formation or progression. IOP was significantly lower with TE in comparison to NPGS at each patient follow-up period.
Treating glaucoma with TE does not seem advisable when considering the associated surgical complications and costs, the authors said. Each complication was more likely to occur with TE than NPGS.
Results indicated that TE is more effective at lowering IOP, but the risk of complications after the procedure is higher than that of NPGS.
“Further studies with larger samples, longer follow-up and also analyzing aspects that we did not take into account, such as quality of life and costs, are warranted to assess the long-term efficacy and safety of TE and NPGS,” the authors wrote. – by Erin T. Welsh
Disclosure: Gabai reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.