Glaucoma surgery techniques compared in large-scale Medicare patient study

The claims records of 14,491 Medicare beneficiaries with glaucoma who were treated with an incisional surgery, either primary trabeculectomy, trabeculectomy in the presence of scarring from previous ocular surgery or trauma, or implantation of a glaucoma drainage device between 1994 and 2003 were evaluated.

San Francisco-The claims records of 14,491 Medicare beneficiaries with glaucoma who were treated with an incisional surgery, either primary trabeculectomy (PT), trabeculectomy in the presence of scarring from previous ocular surgery or trauma (TS), or implantation of a glaucoma drainage device (GDD) between 1994 and 2003 were evaluated by Frank A. Sloan, PhD, and colleagues.

It was found that although adverse outcomes were uncommon for all three options, rates of severe outcomes, less severe outcomes, and progression to low vision or blindness were higher for individuals who received GDD than for those who received PT or TS.

Each surgical technique was designed to improve drainage of fluid from the eye to reduce IOP. In both PT and TS a small portion of the trabecular meshwork is removed to increase fluid flow, and in GDD a tiny implanted shunt is used to bypass the trabecular meshwork and redirect fluid flow. It was stated by some studies that GDD performed earlier in complicated glaucoma might provide benefit with fewer outcomes, which is why this study compared GDD, PT, and TS.

Study patients were at least 68 years of age but not older than 96 during the time of evaluation. Study population was diverse, however, the patients treated with GDD were disproportionately African-American, a group at higher risk than other ethnicities of developing glaucoma-related blindness.