Effectiveness and Safety of Trabeculectomy Versus Tube Shunt Implantation for Uveitic Glaucoma: A Systematic Review and Meta-Analysis

Hashem Abu Serhan; Saleh A Ba-Shammakh; Amr K Hassan; Carina T Sanvicente; Abdelrahman M Anter; M Basil Marchi; Joshua D Stein; Richard K Lee; Ahmed B Sallam; Abdelrahman M Elhusseiny

doi:10.1016/j.ajo.2024.08.045

Effectiveness and Safety of Trabeculectomy Versus Tube Shunt Implantation for Uveitic Glaucoma: A Systematic Review and Meta-Analysis

Am J Ophthalmol. 2024 Sep 16:268:319-328. doi: 10.1016/j.ajo.2024.08.045. Online ahead of print.

Affiliations

¹ From the Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar.
² Department of General Surgery, Ministry of Health, Amman, Jordan.
³ Department of Ophthalmology, Faculty of Medicine, South Valley University, Egypt.
⁴ Department of Ophthalmology, Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
⁵ Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA.
⁶ Kellogg Eye Center, University of Michigan, Ann Arbor, California, USA.
⁷ Department of Ophthalmology, Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. Electronic address: AMElhusseiny@uams.edu.

PMID: 39293570
DOI: 10.1016/j.ajo.2024.08.045

Abstract

Purpose: To evaluate the effectiveness and safety of trabeculectomy compared to glaucoma drainage devices (GDDs) in managing uveitic glaucoma (UG).

Design: Systematic review.

Methods: We searched seven electronic databases (PubMed, Scopus, Web of Science, ScienceDirect, EMBASE, CENTRAL, and Google Scholar) to compare trabeculectomy with various GDDs in UG. The primary outcome was intraocular pressure (IOP) reduction, and secondary outcomes included postoperative complications. We fitted a random effects model for meta-analysis and assessed the risk of bias using the National Institute of Health quality assessment tool.

Results: We included eight studies; 197 eyes underwent trabeculectomy, and 277 eyes had GDDs. The mean age of participants was 48.5 years, with ∼53.5% being male in the trabeculectomy group and 49.3% in the GDDs group. The meta-analysis revealed no significant difference in IOP reduction between trabeculectomy and GDDs (P = .48). Subgroup analyses revealed no significant difference in IOP reduction between trabeculectomy and either the Ahmed glaucoma drainage device group (P = .38) or the Baerveldt glaucoma implant group (P = .90). GDDs were associated with higher rates of complications such as cystoid macular edema (CME) (15% vs. 4%, P < .001), need for revision surgery (11% vs. 6%, P = .04), and uveitic flare (5% vs. 0%, P = .001). However, trabeculectomy had a higher risk of cataract progression (7% vs. 1%, P < .001).

Conclusion: Trabeculectomy and GDDs demonstrated comparable effectiveness in reducing IOP or glaucoma medication reduction in UG. However, there were significant differences in their safety profiles; CME and revisions were higher in GDD, and cataract progression was higher after trabeculectomy.

Publication types

Review