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  • MicroShunt or Trabeculectomy for POAG

    By Lynda Seminara
    Selected by Stephen D. McLeod, MD
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    Journal Highlights

    Ophthalmology, December 2021

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    Baker et al. described interim findings of a two-year randomized study of the MicroShunt versus trabeculectomy in the treatment of primary open-angle glaucoma (POAG). By year 1, trabe­culectomy had achieved greater reduc­tions in IOP.

    This ongoing study includes adults with mild to severe POAG that is not adequately controlled by maximum-tolerated medical treatment (age range, 40-85 years; IOP range, 15 to 40 mm Hg). Patients were assigned randomly (1:3) to undergo trabeculectomy or implantation of the MicroShunt. All received adjunctive mitomycin C (0.2 mg/mL for two minutes).

    Surgical success was the primary ef­fectiveness measure and was defined as reduction of at least 20% in mean diur­nal IOP from baseline (no medication washout) to year 1, with no increase in the number of glaucoma medica­tions. Additional endpoints were mean change in IOP from baseline, need for post-op intervention, number of glau­coma medications, and adverse events.

    Altogether, 132 patients underwent trabeculectomy, and 395 received the MicroShunt. Results at year 1 were as follows:

    • Surgical success was less common in the MicroShunt group than in the tra­beculectomy cohort (53.9% vs. 72.7%; p < .01).
    • Mean IOP in the MicroShunt group declined from 21.1 mm Hg at baseline to 14.3 mm Hg at one year. In compar­ison, mean IOP decreased from 21.1 mm Hg at baseline to 11.1 mm Hg at one year in those who underwent trabeculectomy (p < .01 for both).
    • The mean number of glaucoma medications decreased from 3.1 at baseline to 0.6 by one year in the MicroShunt cohort and from 3.0 at baseline to 0.3 by one year in the trabeculectomy group (p < .01 for both).
    • Postoperative interventions, includ­ing laser suture lysis, were reported for 40.8% of the MicroShunt group and 67.4% of the trabeculectomy group. Transient hypotony was more common with trabeculectomy (49.6% vs. 28.9%; p < .01). Vision-threatening complica­tions were rare with both procedures.

    The original article can be found here.