Document Detail

Meta-analysis of viscocanalostomy versus trabeculectomy in uncontrolled glaucoma.
MedLine Citation:
PMID:  20179632     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Compare the efficacy and safety profile of viscocanalostomy versus trabeculectomy in uncontrolled glaucoma.
PATIENTS AND METHODS: We looked through various search engines for randomized controlled trials directly comparing viscocanalostomy with trabeculectomy. Outcome measurements we examined were mean intraocular pressure difference at 6 months, 12 months, and 24 months, mean difference in postoperative number of antiglaucomatous medications and relative risk of adverse events. Subgroup analysis looked at studies that included 1 eye per patient, studies that included only white patients, studies with only primary open angle glaucoma, studies that did not allow the use of intraoperative mitomycin C in trabeculectomy treatment, studies that did not allow any postoperative use of antimetabolites, and studies with and without the use of postviscocanalostomy Nd:YAG goniopuncture.
RESULTS: Ten randomized controlled trials were selected and included in the meta-analysis with a total of 458 eyes of 397 patients with medically uncontrolled glaucoma. At 6 months, mean intraocular pressure difference was 2.25 mm Hg (95% confidence interval 1.38-3.12), at 12 months it was 3.64 mm Hg (2.74, 4.54), whereas at 24 months it was 3.42 mm Hg (1.80, 5.03). Trabeculectomy was found to have a significantly better pressure-lowering outcome (P<0.0001). Relative risk of adverse events such as perforation of Descemet membrane, hypotony, hyphema, shallow anterior chamber, and cataract formation, were found to be 7.72 (2.37, 25.12), 0.29 (0.15, 0.58), 0.50 (0.30, 0.84), 0.19 (0.08, 0.45), and 0.31 (0.15, 0.64), respectively. Viscocanalostomy had a significantly higher relative risk of intraoperative perforation of Descemet membrane, whereas trabeculectomy had significantly more postoperative adverse events (P≤0.008).
CONCLUSIONS: Trabeculectomy was found to have a greater pressure-lowering effect compared with viscocanalostomy. However, viscocanalostomy had a significantly better risk profile.
Charmaine Chai; Seng Chee Loon
Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis    
Journal Detail:
Title:  Journal of glaucoma     Volume:  19     ISSN:  1536-481X     ISO Abbreviation:  J. Glaucoma     Publication Date:    2010 Oct-Nov
Date Detail:
Created Date:  2010-10-15     Completed Date:  2011-01-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9300903     Medline TA:  J Glaucoma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  519-27     Citation Subset:  IM    
National University Singapore, National University Hospital, Singapore.
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MeSH Terms
Antihypertensive Agents / administration & dosage
Glaucoma / physiopathology,  surgery*
Hyaluronic Acid / administration & dosage
Intraocular Pressure / physiology
Intraoperative Complications
Middle Aged
Postoperative Complications
Randomized Controlled Trials as Topic
Sclerostomy / adverse effects,  methods*
Trabeculectomy / adverse effects,  methods*
Treatment Outcome
Viscosupplements / administration & dosage
Reg. No./Substance:
0/Antihypertensive Agents; 0/Viscosupplements; 9004-61-9/Hyaluronic Acid

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