Combining Baerveldt Implant with Trabectome Negates Tube Fenestration: A Coarsened-matched Comparison

PURPOSE: To assess the efficacy and survival rate of the Trabectome-mediated ab interno trabeculectomy combined with non-fenestrated Baerveldt glaucoma implant compared with the Baerveldt glaucoma implant alone. METHODS: In this retrospective comparative case series, 175 eyes undergoing primary glaucoma surgery (Baerveldt–Trabectome [BT] group: 60 eyes and Baerveldt [B] group: 115 eyes) were included. Participants were identified using the procedural terminology codes. Groups were then matched by Coarsened Exact Matching that resulted in the inclusion of 51 eyes in each group. The primary outcome measure was surgical success defined as 5 mmHg [Formula: see text] intraocular pressure (IOP) [Formula: see text] 21 mmHg, and IOP reduction [Formula: see text] 20% from baseline, and no need to reoperation for glaucoma. Secondary outcome measures were IOP, number of glaucoma medications, and best-corrected visual acuity (BCVA). RESULTS: The cumulative probability of success at one year was 61% in the BT group and 50% in the B group. IOP decreased from 23.5 [Formula: see text] 2.4 mmHg at baseline to 14.1 [Formula: see text] 2.7 mmHg at the final follow-up in the BT group (P = 0.001). The corresponding values for the B group were 23.2 [Formula: see text] 2.0 mmHg and 13.9 [Formula: see text] 1.6 mmHg, respectively (P = 0.001). There was no significant difference between the groups in terms of IOP at the final follow-up (P = 0.56). The number of medications at baseline was 2.3 [Formula: see text] 0.3 in both groups. However, the BT group needed fewer drops at all postoperative time intervals and used 1.1 [Formula: see text] 0.3 versus 2.0 [Formula: see text] 0.4 eye drops (group B) at the final follow-up visit (P = 0.004). Eyes in B with phacoemulsification had a significantly higher IOP on day 1 compared to B (23.2 [Formula: see text] 14.3 versus 17.9 [Formula: see text] 11.4, P = 0.041). During the one-year follow-up, 7 (13.7%) patients in BT group and 18 (35.2%) in B group experienced hypotony (P = 0.04). No dangerous hypotony or hypertension occurred in BT group. The mean BCVA at baseline was 0.64 [Formula: see text] 0.85 logMAR and changed to 0.55 [Formula: see text] 0.75 logMAR in BT and B groups, respectively (P = 0.663). The corresponding numbers for the final follow-up visit was 0.72 [Formula: see text] 1.07 and 0.63 [Formula: see text] 0.97 logMAR, respectively (P = 0.668). CONCLUSION: We observed similar rates of success and IOP reduction using BT and B techniques. BT group needed fewer glaucoma medications. Tube fenestration was unnecessary in BT group resulting in less postoperative ocular hypotony and hypertension. The results of our study indicate that additional trabectome procedure makes Baerveldt glaucoma implant safer, easier to handle, and more predictable in the most vulnerable patients with advanced glaucoma.