title: Trabeculectomy versus canaloplasty (TVC study) in the treatment of patients with open-angle glaucoma: a prospective randomized clinical trial.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Ophthalmology, University of Würzburg, Würzburg, Germany.
authors.forename: Juliane
authors.initials: J
authors.lastname: Matlach
authors.affiliation: Department of Ophthalmology, University of Würzburg, Würzburg, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Dhillon
authors.affiliation: Department of Mathematics, University of Würzburg, Würzburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Hain
authors.affiliation: Department of Ophthalmology, University of Würzburg, Würzburg, Germany.|Eye Center, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
authors.forename: Günther
authors.initials: G
authors.lastname: Schlunck
authors.affiliation: Department of Ophthalmology, University of Würzburg, Würzburg, Germany.
authors.forename: Franz
authors.initials: F
authors.lastname: Grehn
authors.affiliation: Department of Ophthalmology, University of Würzburg, Würzburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Klink
mesh_terms: D000368:Aged; D001082:Aqueous Humor / Q000502:physiology; D005260:Female; D018463:Filtering Surgery; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D014065:Tonometry, Ocular; D014130:Trabeculectomy; D014792:Visual Acuity / Q000502:physiology
keywords: canaloplasty; glaucoma surgery; open-angle glaucoma; trabeculectomy
references.citation: Graefes Arch Clin Exp Ophthalmol. 2004 Feb;242(2):106-113
references.pmid: 14648140
references.citation: J Cataract Refract Surg. 2007 Jul;33(7):1217-26
references.pmid: 17586378
references.citation: J Cataract Refract Surg. 2008 Mar;34(3):433-40
references.pmid: 18299068
references.citation: Curr Opin Ophthalmol. 2009 Mar;20(2):116-21
references.pmid: 19240543
references.citation: J Cataract Refract Surg. 2009 May;35(5):814-24
references.pmid: 19393879
references.citation: J Glaucoma. 2011 Jan;20(1):28-9
references.pmid: 20440218
references.citation: Br J Ophthalmol. 2010 Nov;94(11):1478-82
references.pmid: 20962352
references.citation: J Glaucoma. 2012 Feb;21(2):89-94
references.pmid: 21278586
references.citation: J Cataract Refract Surg. 2011 Apr;37(4):682-90
references.pmid: 21420593
references.citation: Cornea. 2011 Jun;30(6):718-9
references.pmid: 21562459
references.citation: Ophthalmology. 2011 Jul;118(7):1466-80
references.pmid: 21724045
references.citation: Graefes Arch Clin Exp Ophthalmol. 2011 Oct;249(10):1537-45
references.pmid: 21732110
references.citation: Ophthalmology. 2011 Dec;118(12):2427-33
references.pmid: 21856008
references.citation: Acta Ophthalmol. 2013 Mar;91(2):151-6
references.pmid: 22151545
references.citation: J Glaucoma. 2013 Mar;22(3):201-4
references.pmid: 22157515
references.citation: Ophthalmology. 2012 Apr;119(4):712-22
references.pmid: 22244944
references.citation: Curr Opin Ophthalmol. 2012 Mar;23(2):118-26
references.pmid: 22249235
references.citation: Dev Ophthalmol. 2012;50:109-24
references.pmid: 22517178
references.citation: J Glaucoma. 2014 Jan;23(1):33-4
references.pmid: 23221902
references.citation: BMC Ophthalmol. 2013 Jan 29;13:1
references.pmid: 23360243
references.citation: J Glaucoma. 2014 Jun-Jul;23(5):316-20
references.pmid: 23377581
references.citation: J Glaucoma. 2015 Mar;24(3):187-94
references.pmid: 23429620
references.citation: Cornea. 2013 May;32(5):712-3
references.pmid: 23449481
references.citation: J Glaucoma. 2013 Sep;22(7):577-83
references.pmid: 23632395
references.citation: Acta Ophthalmol. 2013 Sep;91(6):e420-6
references.pmid: 23819592
references.citation: Saudi J Ophthalmol. 2011 Oct;25(4):329-36
references.pmid: 23960946
references.citation: Acta Ophthalmol. 2014 Aug;92(5):426-31
references.pmid: 24020653
references.citation: Ophthalmic Res. 2013;50(4):197-208
references.pmid: 24030362
references.citation: J Glaucoma. 2015 Sep;24(7):543-9
references.pmid: 24240873
references.citation: Am J Ophthalmol. 1968 Oct;66(4):673-9
references.pmid: 4891876