Two-Year Outcome of Surgery in Glaucoma Patients

Abstract

Purpose To evaluate the 2-year surgical treatment outcome in glaucoma patients.

Methods A retrospective, single-center, interventional study was performed on 160 eyes of 125 patients suffering glaucoma, including POAG (82 eyes), pseudoexfoliation (PEX) (59 eyes), pigment dispersion (8 eyes), and secondary glaucoma (2 eyes). Eyes with uncontrolled intraocular pressure (IOP) or signs of glaucoma progression despite medical treatment were included to undergo either trabeculectomy (TE), XEN implantation, combined TE with phacoemulsification (TE + IOL), or XEN implantation with phacoemulsification surgery (XEN + IOL). Primary efficacy outcome was the mean IOP reduction. Secondary outcome was the mean reduction in the number of medications. The data were compared at baseline vs.1 day, 1 week, and 1, 3, 6, 12, and 24 months following surgery. For statistical evaluation, ANOVA-based linear mixed-effects models were performed with SPSS.

Results The mean IOP reduction in a 2-year follow-up was 30.31% (22.17 vs. 15.45 mmHg, p < 0.001). The mean number of antiglaucoma medications was reduced from 2.87 to 0.58 (p = 0.001), where TE alone or combined surgeries seemed to be more effective than isolated XEN surgery. Transient IOP hypotony on the first postoperative day occurred in PEX patients following TE surgery (p = 0.024). At 6 months, PEX patients with isolated XEN surgery showed a transient IOP increase, whereas those after combined TE + IOL surgery showed the lowest IOP within the PEX group compared to other glaucoma patients (p < 0.026).

Conclusions After 2 years, all performed glaucoma surgeries achieved a significant reduction in IOP and the number of antiglaucoma medications.

Zusammenfassung

Absicht Evaluierung des Outcomes in den ersten 2 Jahren nach Chirurgie bei Glaukompatienten.

Methoden Eine retrospektive, Single-Center-Studie wurde bei 160 Augen von 125 Glaukompatienten durchgeführt, miteingeschlossen: POWG (82 Augen), PEX (59 Augen), Pigmentdispersion (8 Augen) und Sekundärglaukom (2 Augen). Augen mit dekompensiertem Intraokulardruck (IOD) oder Zeichen einer Glaukomprogression trotz medikamentöser Therapie wurden eingeschlossen, um sich einer Trabekulektomie (TE), XEN-Implantation, kombinierter TE mit Phakoemulsifikation (Phaco-TE) oder XEN-Implantation mit Phakoemulsifikation (Phaco-XEN) zu unterziehen. Der primäre Wirksamkeitsendpunkt war die mittlere Reduktion des IODs. Sekundär wurde das Outcome der Reduktion der Anzahl Medikamentenwirkstoffe überprüft. Die Daten wurden verglichen zwischen präoperativen Werten und 1. Tag, 1. Woche, 1., 3., 6., 12. und 24. Monat postoperativ nach Glaukomchirurgie. Für die statistische Evaluation wurden ANOVA-basierte lineare, gemischte Modelle verwendet, erzeugt mit SPSS.

Resultate Die mittlere IOD-Reduktion nach 2 Jahren war 30,31% (22,17 zu 15,45 mmHg, p < 0,001). Die mittlere Anzahl der antiglaukomatösen Medikamente wurde von 2,87 auf 0,58 (p = 0,001) reduziert, wobei die TE und Phaco-TE einen Trend zur besseren Effektivität als die isolierte XEN-Implantation zeigen. Transiente IOD-Hypotonie am 1. postoperativen Tag traten bei PEX-Patienten nach TE-Chirurgie auf (p = 0,024). Nach 6 Monaten zeigten PEX-Patienten nach isolierter XEN-Implantation einen transienten IOD-Anstieg, wogegen jene nach Phaco-TE den niedrigsten IOD sowohl in der PEX-Gruppe als auch verglichen mit anderen Glaukompatienten zeigten (p < 0,026).

Schlussfolgerungen Nach 2 Jahren zeigte sich in allen durchgeführten glaukomchirurgischen Eingriffen eine signifikante Reduktion des IODs und der Reduktion der Anzahl Glaukommedikamente.

Key words

glaucoma - surgery - minimally invasive glaucoma surgery - trabeculectomy - XEN

Schlüsselwörter

Glaukom - Chirurgie - minimalinvasive Glaukomchirurgie - Trabekulektomie - XEN

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