One-year outcomes of microshunt implantation in pseudoexfoliation glaucoma.

Matthias Nobl,Sigrid Freissinger,Stefan Kassumeh,Siegfried Priglinger,Marc J Mackert,Ahmed Awadein

doi:10.1371/journal.pone.0256670

Matthias Nobl, Sigrid Freissinger + Show 4 more

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https://doi.org/10.1371/journal.pone.0256670

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Journal: PloS one	Publication Date: Aug 27, 2021
Citations: 13	License type: CC BY 4.0

Affiliation: Ludwig-Maximilians-Universität München

Abstract

PurposeTo compare the safety and efficacy of microshunt implantation augmented with Mitomycin C in patients with pseudoexfoliation glaucoma (PEXG) and primary open-angle glaucoma (POAG).MethodsIn this retrospective, single centre, interventional study, 46 eyes of 41 patients with PEXG (20 eyes) and POAG (26 eyes) underwent microshunt implantation. Definition of failure was an intraocular pressure (IOP) lower than 5 or higher than 17mmHg on two consecutive visits, an IOP reduction lower than 20% on two consecutive visits, the need of surgical revisions or reoperations or loss of light perception. Outcome was rated as complete success if achieved without medication, otherwise as qualified success. Furthermore, postoperative complications and interventions were compared between the two groups.ResultsPatient demographics were similar, except for older age in the PEXG group (70.9±8.6 versus 77.6±8; p = 0.02). Mean IOP dropped from 21.5±5.8mmHg (PEXG) and 18.2±4.5mmHg (POAG) at baseline to 12.8±3.0mmHg (p<0.0001) and 12.9±4.2mmHg (p<0.0001), respectively, at one year. Mean number of medications were reduced from 2.8±1.3 to 0.3±0.8 for PEXG patients (p<0.0001) and from 2.7±1.3 to 0.3±0.8 for POAG patients (p<0.0001). At one year of follow-up 75.0% of PEXG patients achieved complete success and 80.0% qualified success. In the POAG group rates were 73.1% and 76.9%, respectively. Postoperative complications were comparable between both groups, except for higher rates of hypotony (p = 0.04) and choroidal detachment (p = 0.03) in the PEXG group.ConclusionMicroshunt implantation demonstrated similar efficacy results in PEXG and POAG eyes at a follow-up of 12 months. Higher rates of transient hypotony and choroidal detachment were observed in PEXG eyes.

Highlights

Glaucoma is a common disease and one of the leading causes of blindness worldwide
Higher rates of transient hypotony and choroidal detachment were observed in Pseudoexfoliation glaucoma (PEXG) eyes
In contrast to primary open angle glaucoma (POAG), patients suffering from PEXG are often older, show a higher intraocular pressure (IOP) and more advanced visual field defects at initial presentation [4]

Summary

Introduction

Glaucoma is a common disease and one of the leading causes of blindness worldwide. The number of persons affected by glaucoma is predestined to rise significantly over the years mostly due to the aging population [1]. In patients showing advanced visual field defects, insufficiently controlled intraocular pressure (IOP) despite medical treatment or side effects of eye drop therapy, filtering surgery is often required to stop or slow the disease progression. In contrast to primary open angle glaucoma (POAG), patients suffering from PEXG are often older, show a higher IOP and more advanced visual field defects at initial presentation [4]. PEXG shows a higher short-term fluctuation in IOP [5]. Taking these findings into account PEXG seems to be more difficult to manage [4]. It is known that PEXG shows a more rapidly progressive course and that the topical medical treatment is more likely to fail in slowing this progression in the long-term [6,7]. It was speculated that surgery might exacerbate preexisting blood aqueous barrier breakdown in PEXG, leading to more severe postoperative inflammation and accelerating bleb scarring and worsening of bleb function [8,9]

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