Visual rehabilitation in subconjunctival MIGS versus trabeculectomy and tube shunt surgery

Abstract

Background

To compare recovery of baseline visual acuity and persistent visual loss at 12-months in standalone subconjunctival minimally invasive glaucoma surgery (MIGS) vs trabeculectomy and tube shunt surgery in manifest and suspect glaucoma.

Design

Retrospective international multicenter study

Methods

Analysis of 974 eyes (Xen, 359; Trab, 455; Tube 160) of 847 subjects that underwent standalone Xen45 gel stent (Xen, 87 % ab-interno), trabeculectomy (Trab) or tube shunt (Tube) surgery with 12 months of follow-up. The primary outcome was time for visual acuity (VA) to return to within five letters of pre-operative baseline.

Results

The baseline glaucoma severity was significantly worse in the Tube group (mean deviation -10.4 vs -12.9 vs -14.4 dB in Xen vs Trab vs Tube, P < 0.001). The proportion of eyes that returned to within 5 letters of baseline VA at 12 months was 93.0 %, 88.6 % and 89.4 % respectively. Compared to the Trab group, the Xen had a significantly shorter median recovery time (9 vs 15 vs 15 days) and higher likelihood of return to baseline VA, including in a subcohort propensity score matched by baseline characteristics (OR 1.48, CI 1.18–1.87, P < 0.001). The Xen group however displayed lower surgical success than the Trab group. There was no significant difference in the rate of VA loss at 12 months (2.5 % vs 2.5 % vs 5 %, P = 0.21).

Conclusions

Subconjunctival minimally invasive glaucoma surgery displayed the fastest and a higher likelihood of return to baseline visual acuity compared to Trab and Tube surgery.