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Longer-Term Baerveldt to Trabectome Glaucoma Surgery Comparison using Propensity Score Matching

Kostanyan, Tigran and Shazly, Tarek and Kaplowitz, Kevin B. and Wang, Steven Z. and Kola, Sushma and Brown, Eric N. and Loewen, Nils A. (2017) Longer-Term Baerveldt to Trabectome Glaucoma Surgery Comparison using Propensity Score Matching. (Submitted)

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Purpose: To apply propensity score matching to compare Baerveldt glaucoma drainage implants (BGI) to trabectome-mediated ab interno trabeculectomy (AIT). Recent data suggests that AIT can produce results similar to BGI which is traditionally reserved for more severe glaucoma.
Methods: BGI and AIT patients with at least one year of follow-up were included. The primary outcome measures were intraocular pressure (IOP), number of 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 with neovascular glaucoma, with prior glaucoma surgery or without a close match were excluded.
Results: Of 353 patients, 30 AIT patients were matched to 29 BGI patients. Baseline characteristics including, IOP, the number of glaucoma medications, type of glaucoma , the degree of VF loss and GI were not significantly different between AIT and BGI. BGI had a preoperative IOP of 21.6±6.3 mmHg compared to 21.5±7.4 for AIT on 2.8±1.1 medications and 2.5±2.3, respectively. At 30 months, the mean IOP was 15.0±3.9 mmHg for AIT versus 15.0±5.7 mmHg for BGI (p>0.05), while the number of drops was 1.5±1.3 for AIT (change: p=0.001) versus 2.4±1.2 for BGI (change: p=0.17; AIT vs BGI: 0.007). Success, defined as IOP<21 mmHg, <20% reduction and no reoperation, was achieved at 1 year in 56% of AIT versus 55% of BGI (p>0.05) and 50% versus 52% at 2.5 years.
Conclusions: A propensity score matched comparison of AIT and BGI demonstrated a similar IOP reduction through one year. AIT required fewer medications.


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Item Type: Article
Status: Submitted
CreatorsEmailPitt UsernameORCID
Kostanyan, Tigran
Shazly, Tarek
Kaplowitz, Kevin B.
Wang, Steven Z.
Kola, Sushmasuk55@pitt.eduSUK55
Brown, Eric N.
Loewen, Nils A.nal58@pitt.eduNAL580000-0001-7167-1213
Date: 13 March 2017
Date Type: Submission
Schools and Programs: School of Medicine > Ophthalmology
Refereed: No
Funders: Eye and Ear Foundation of Pittsburgh, Initiative to Cure Glaucoma
Article Type: Research Article
MeSH Headings: glaucoma; glaucoma surgery; trabectome; MIGS; microincisional glaucoma surgery; Baerveldt tube shunt
Date Deposited: 17 Mar 2017 13:58
Last Modified: 17 Mar 2017 13:58


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