Meta-analysis of viscocanalostomy versus trabeculectomy in uncontrolled glaucoma.
OBJECTIVE
Compare the efficacy and safety profile of viscocanalostomy versus trabeculectomy in uncontrolled glaucoma.


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.
Chai
Charmaine
C
National University Singapore, National University Hospital, Singapore.
Loon
Seng Chee
SC
D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage; D005260:Female; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D007429:Intraocular Pressure / Q000502:physiology; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic; D012599:Sclerostomy / Q000009:adverse effects / Q000379:methods*; D014130:Trabeculectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055675:Viscosupplements / Q000008:administration & dosage
D000959:Antihypertensive Agents; D055675:Viscosupplements; D006820:Hyaluronic Acid