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Trabeculectomy versus canaloplasty ( TVC study) in the treatment of patients with open‐angle glaucoma: a prospective randomized clinical trial
Author(s) -
Matlach Juliane,
Dhillon Christine,
Hain Johannes,
Schlunck Günther,
Grehn Franz,
Klink Thomas
Publication year - 2015
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.12722
Subject(s) - trabeculectomy , medicine , intraocular pressure , glaucoma , ophthalmology , visual acuity , clinical endpoint , prospective cohort study , glaucoma surgery , open angle glaucoma , surgery , randomized controlled trial
Purpose To compare the outcomes of canaloplasty and trabeculectomy in open‐angle glaucoma. Methods This prospective, randomized clinical trial included 62 patients who randomly received trabeculectomy ( n = 32) or canaloplasty ( n = 30) and were followed up prospectively for 2 years. Primary endpoint was complete (without medication) and qualified success (with or without medication) defined as an intraocular pressure ( IOP ) of ≤18 mmHg (definition 1) or IOP ≤21 mmHg and ≥20% IOP reduction (definition 2), IOP ≥5 mmHg, no vision loss and no further glaucoma surgery. Secondary endpoints were the absolute IOP reduction, visual acuity, medication, complications and second surgeries. Results Surgical treatment significantly reduced IOP in both groups (p < 0.001). Complete success was achieved in 74.2% and 39.1% (definition 1, p = 0.01), and 67.7% and 39.1% (definition 2, p = 0.04) after 2 years in the trabeculectomy and canaloplasty group, respectively. Mean absolute IOP reduction was 10.8 ± 6.9 mmHg in the trabeculectomy and 9.3 ± 5.7 mmHg in the canaloplasty group after 2 years (p = 0.47). Mean IOP was 11.5 ± 3.4 mmHg in the trabeculectomy and 14.4 ± 4.2 mmHg in the canaloplasty group after 2 years. Following trabeculectomy, complications were more frequent including hypotony (37.5%), choroidal detachment (12.5%) and elevated IOP (25.0%). Conclusions Trabeculectomy is associated with a stronger IOP reduction and less need for medication at the cost of a higher rate of complications. If target pressure is attainable by moderate IOP reduction, canaloplasty may be considered for its relative ease of postoperative care and lack of complications.