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Similar Performance of Trabectome and Ahmed Glaucoma Devices in a Propensity Score Matched Comparison.

Esfandiari, Hamed and Shazly, Tarek and Waxman, Susannah and Kola, Sushma and Kaplowitz, Kevin B and Brown, Eric N and Loewen, Nils A (2018) Similar Performance of Trabectome and Ahmed Glaucoma Devices in a Propensity Score Matched Comparison. J Glaucoma.

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PURPOSE: To apply propensity score matching to Ahmed glaucoma drainage implants (AGI) to trabectome-mediated ab interno trabeculectomy (AIT). Recent data suggests that AIT can produce results similar to AGI traditionally reserved for more severe glaucoma. METHODS: AGI and AIT patients with at least one year of follow-up were included. The primary outcome measures were intraocular pressure (IOP), glaucoma medications, and a Glaucoma Index (GI) score. GI reflected glaucoma severity based on visual field, the number of preoperative medications, and preoperative IOP. Score matching used a genetic algorithm consisting of age, gender, type of glaucoma, concurrent phacoemulsification, baseline number of medications, and baseline IOP. Patients without a close match were excluded. RESULTS: Of 152 patients, 34 AIT patients were matched to 32 AGI patients. Baseline characteristics including ethnicity, IOP, the number of medications, glaucoma type, the degree of VF loss and GI were not significantly different between AIT and AGI. AIT had a preoperative IOP of 23.6±8.1▒mm Hg compared to 26.5+10.6 for AGI. At 12 months, the mean IOP was 15.0±9▒mm Hg for AIT versus 15.0±4▒mm Hg for AGI (P=0.8), while the number of drops was 2.3±2.2 for AIT versus 3.6±1.3 for AGI (P=0.016). Only 6 AIT patients (17.6%) required further surgery within the first 12 months versus 9 (28%) for AGI. Success, defined as IOP<21▒mm Hg, <20% reduction and no reoperation, was achieved in 76% of AIT versus 69% of AGI (P=0.48). Complications occurred in 13% of AGI and 0.8% of AIT. CONCLUSIONS: A propensity score matched comparison of AIT and AGI demonstrated an equivalent IOP reduction through one year. Surprisingly, the AGI group required more glaucoma medications than the AIT group at 6 and 12 months.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Esfandiari, Hamed
Shazly, Tarek
Waxman, Susannah
Kola, Sushma
Kaplowitz, Kevin B
Brown, Eric N
Loewen, Nils Anal58@pitt.eduNAL58
Date: 2 April 2018
Date Type: Publication
Journal or Publication Title: J Glaucoma
DOI or Unique Handle: 10.1097/ijg.0000000000000960
Schools and Programs: School of Medicine > Ophthalmology
Refereed: No
MeSH Headings: Glaucoma; glaucoma surgery; MIGS; microincisional glaucoma surgery; glaucoma drainage implants; Ahmed glaucoma implant
Date Deposited: 16 Mar 2017 14:34
Last Modified: 18 Apr 2018 01:55


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