Combined Visco-Trab operation: A dual filtration pathway for management of advanced glaucoma—midterm results

PURPOSE: To study midterm efficacy and safety of combined Visco-Trab operation for management of advanced glaucoma. METHODS: 168 eyes of 148 patients with advanced glaucoma had Visco-Trab operation (a merge of both viscocanalostomy and trabeculectomy operations). Mean follow-up was 29.1 ± 22.2 months. Criteria of success were intraocular pressure (IOP) of 14 mmHg or less with or without glaucoma medications, with no devastating complications, loss of light perception, or additional glaucoma surgery. RESULTS: IOP, number of glaucoma drops, and visual field mean deviation were significantly reduced (11.9 ± 5.6 mmHg, 0.7 ± 1.2, and 14.2 ± 6.3 dB, compared to preoperative values of 24.4 ± 9.9 mmHg, 2.8 ± 1.4, and 17.3 ± 6.3 dB, respectively). Success was reported in 136 of 168 eyes (81%) without (100 eyes, 59.5%) or with (36 eyes, 21.5%) glaucoma medications. A functioning bleb was seen in 2/3rd of eyes; diffuse (59 eyes, 35%) and thin ischemic (54 eyes, 32%). Predictors for failure to achieve the target IOP included previous ocular (p = 0.01) or glaucoma (p = 0.04) surgery, number of preoperative glaucoma medications (p = 0.029), and severity of glaucoma (p = 0.058). CONCLUSION: Combined Visco-Trab operation proved safe and effective, on midterm follow-up, in reducing IOP to the proposed target level in eyes with severe glaucoma via enhancing internal and external filtration. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at (10.1007/s10792-021-01698-0).