Eduardo Akio Pereira I

Précis: In this randomized multicenter trial, both TRAB and CPC lowered IOP at 12 months as primary glaucoma surgeries, with TRAB yielding lower final IOP with fewer medications, while both procedures demonstrated meaningful clinical effectiveness. Purpose: To compare the efficacy and safety of trabeculectomy (TRAB) and slow-burn transscleral cyclophotocoagulation (CPC) as primary surgical treatments for glaucoma. Methods: Prospective, randomized, multicenter trial including one eye per patient from July 2020 to July 2023, with 12-month follow-up. Participants were allocated to TRAB (GI) or CPC (GII). The primary endpoint was surgical success at 12 months, defined by intraocular pressure (IOP) between 6 and 18 mm Hg without non-protocol glaucoma surgery or serious complications. Results: Eighty-six eyes were included; nine were excluded (four in GI; five in GII). Baseline demographics were similar between groups. Both significantly reduced IOP at 12 months (GI: 22.97±8.23 mm Hg to 10.14±2.89 mm Hg; GII: 23.47±6.34 mm Hg to 14.58±3.66 mm Hg; P P P =0.007). Final IOP between 6 and 18 mm Hg was reached by 97.1% of GI and 90.9% of GII ( P =0.708). Qualified success rates were high and comparable (GI: 97.4%; GII: 86.8%; P =0.08), while complications were infrequent (four in GI; one in GII; P =0.3). Quality of life improved after TRAB (EQ-5D: 0.71±0.19 to 0.78±0.14; P =0.031) but remained unchanged after CPC ( P =0.424). Conclusions: Both procedures reduced IOP at 12 months as primary glaucoma surgeries. TRAB achieved lower final IOP, required fewer medications, and was associated with improved quality of life, whereas CPC required more adjunctive medication and retreatment in some eyes.

This retrospective, comparative, multicenter study aimed to evaluate the real-world outcomes and predictors of failure of Gonioscopy-assisted transluminal trabeculotomy (GATT) at 12 months in glaucoma patients. Predictors of failure of absolute success in bilateral cases (422 eyes of 308 patients) included pre-operative intraocular pressure (IOP; IRR = 1.02; p = 0.01), and pre-operative mean deviation (IRR = 0.98; p = 0.007). The significant predictors of failure of relative success included binocularity (IRR = 4.05; p = 0.001) and pre-operative IOP (IRR = 1.04; p = 0.022). Only one eye per patient (308 eyes) was included in the second analysis. IOP reduced from 21.84 ± 7.96 mmHg to 11.97 ± 2.89 mmHg at 12 months; the number of hypotensive eye drop medications decreased from 3.07 ± 1.04 to 1.06 ± 1.08 (p < 0.001 for both). The pre-operative IOP was a predictive factor for failure of absolute (IRR = 1.02; p = 0.026) and relative successes (IRR = 1.05; p = 0.014). The preoperative number of hypotensive medications only affected absolute success (IRR = 1.25; p = 0.004). The Kaplan–Meier graph revealed relative and absolute success in 88.9% and 43.9% of cases, respectively. In conclusion, GATT is a safe and effective treatment option for diverse forms of open-angle glaucoma with varying severity. Pre-operative number of medications and IOP, race, and the outcomes of the contralateral eye (if applicable) were identified as predictors of failure of the procedure.