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. 2023 Feb 13;13(2):516.
doi: 10.3390/life13020516.

Long-Term Efficacy and Safety of Modified Canaloplasty Versus Trabeculectomy in Open-Angle Glaucoma

Julia V Stingl  1 , Felix M Wagner  1 , Sarah Liebezeit  2 , Raphael Baumgartner  3 , Helene Spät  1 , Alexander K Schuster  1 , Verena Prokosch  4 , Franz Grehn  1 , Esther M Hoffmann  1
Affiliations

Long-Term Efficacy and Safety of Modified Canaloplasty Versus Trabeculectomy in Open-Angle Glaucoma

Julia V Stingl et al. Life (Basel). .

Abstract

Background: To evaluate the long-term efficacy and safety of modified canaloplasty versus trabeculectomy in open-angle glaucoma.

Methods: In total, 210 subjects with open-angle glaucoma were included. 70 were treated with Mitomycin C-augmented modified canaloplasty with enhanced subconjunctival filtration and 140 with Mitomycin C-augmented trabeculectomy. Cases were matched 1:2 by sex and age.

Results: In canaloplasty and trabeculectomy groups, 61.4% and 57.9% of participants were female. Mean age was 60.0 ± 13.9 and 63.0 ± 12.2 years, median follow-up time was 4.6 [IQR 4.3, 5.05] years and 5.8 [IQR 5.4, 6.3]. Strict success was achieved in 20.0% and 56.4%, complete success in 24.3% and 66.4%, and qualified success in 34.3% and 73.6% (each p < 0.001). Kaplan-Meier survival analysis showed a better survival probability for trabeculectomy than for canaloplasty (p < 0.001) and Cox regression analysis revealed an HR of 6.03 (95%-CI 3.66, 9.93, p < 0.001) after canaloplasty. Trabeculectomy showed superiority in terms of IOP decrease (9.2 ± 7.9 mmHg vs. 13.7 ± 10.4 mmHg, p = 0.002), use of AGM (50.0% vs. 10.7%, p < 0.001), and the number of revision surgeries (41.4% vs. 21.4%, p = 0.004). Occurrence of complications was similar in both groups (14.5% vs. 7.5%, p = 0.19).

Conclusions: Trabeculectomy showed superiority in efficacy and equality in safety compared to modified canaloplasty.

Keywords: canaloplasty; glaucoma surgery; long-term outcome; open-angle glaucoma; trabeculectomy.

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Conflict of interest statement

A.K.S. received financial support/grants from Abbvie, Bayer, Heidelberg, Novartis and Santen. E.M.H. received consulting fees from Allergan (AbbVie), Novartis, Heidelberg Engineering and ORA, speaker honoraria from Heidelberg Engineering, Santen, Johnson & Johnson and Thea, and travel support from Johnson & Johnson and Santen.

Figures

Figure 1
Figure 1
Kaplan–Meier survival analysis of complete surgical success (A) and qualified surgical success (B) after modified canaloplasty and trabeculectomy.
Figure 2
Figure 2
Intraocular pressure development. (A): Intraocular pressure before surgery and at last follow-up in both groups. (B): Intraocular pressure before surgery and either at the last follow-up (light colors) or prior to revision surgery (dark colors), if applicable. Abbreviations: IOP, intraocular pressure.
Figure 3
Figure 3
Kaplan–Meier survival analysis of complete surgical success (A) and qualified surgical success (B) after modified canaloplasty and trabeculectomy in primary open-angle glaucoma cases (POAG).
See this image and copyright information in PMC

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