In total, 23 patients were excluded because the surgery did not comply with the standard surgery procedure protocol. We identified 133 eligible patients with a minimum follow-up of three years after surgery. Inclusion criteria were age 18 years or older and a diagnosis of open-angle glaucoma without prior filtering surgery. An electronic surgical case register was searched, and the subjects were manually reviewed for eligibility. Patients with open-angle glaucoma, who had undergone a modified canaloplasty between February 2016 and January 2018 were enrolled in this study. This retrospective cohort study was conducted at the Department of Ophthalmology of the University Medical Center Mainz, Germany. ![]() They further found that enhancement by Mitomycin C lowered the mean difference of IOP between trabeculectomy and deep slerectomy from −2.65 to −0.83 mmHg after 6 months, indicating a better performance of nonpenetrating procedures when applying antifibrotic substances. Another systematic review reported a higher efficacy of trabeculectomy in reducing IOP with a mean difference of −1.53 mmHg compared to deep sclerectomy, −3.84 mmHg compared to viscocanalostomy and −4.40 mmHg compared to canaloplasty 12 months after surgery. A Cochrane review of randomized controlled trials found similar odds for success after deep sclerectomy and trabeculectomy, whereas the odds for success after viscocanalostomy amounted to only a third of the odds for success after trabeculectomy. The efficacy and success of nonpenetrating surgeries have been discussed in the literature. To prevent these adverse events, so-called nonpenetrating procedures comprising deep sclerectomy, viscocanalostomy, and canaloplasty have been developed. These complications are particularly feared in highly myopic eyes, but also short axial length bears risks such as the development of malignant glaucoma. However, these agents have been attributed to the occurrence of severe adverse events such as hypotony, bleb leak, choroidal detachment or hemorrhage, and endophthalmitis. Outcomes have markedly improved since its introduction roughly 50 years ago, among others due to applications of antifibrotics such as mitomycin C (MMC) and 5-fluorouracil (5-FU) to prevent postoperative bleb fibrosis. Today, trabeculectomy is the standard procedure when it comes to glaucoma surgery. Conclusions: Trabeculectomy showed superiority in efficacy and equality in safety compared to modified canaloplasty. Occurrence of complications was similar in both groups (14.5% vs. Trabeculectomy showed superiority in terms of IOP decrease (9.2 ± 7.9 mmHg vs. Kaplan–Meier survival analysis showed a better survival probability for trabeculectomy than for canaloplasty ( p < 0.001) and Cox regression analysis revealed an HR of 6.03 (95%-CI 3.66, 9.93, p < 0.001) after canaloplasty. Strict success was achieved in 20.0% and 56.4%, complete success in 24.3% and 66.4%, and qualified success in 34.3% and 73.6% (each p < 0.001). Mean age was 60.0 ± 13.9 and 63.0 ± 12.2 years, median follow-up time was 4.6 years and 5.8. Results: In canaloplasty and trabeculectomy groups, 61.4% and 57.9% of participants were female. 70 were treated with Mitomycin C-augmented modified canaloplasty with enhanced subconjunctival filtration and 140 with Mitomycin C-augmented trabeculectomy. ![]() Methods: In total, 210 subjects with open-angle glaucoma were included. Background: To evaluate the long-term efficacy and safety of modified canaloplasty versus trabeculectomy in open-angle glaucoma.
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