Visual rehabilitation in subconjunctival MIGS versus trabeculectomy and tube shunt surgery

Background: To compare recovery of baseline visual acuity and persistent visual loss at 12-months in standalone subconjunctival minimally invasive glaucoma surgery (MIGS) vs trabeculectomy and tube shunt surgery in manifest and suspect glaucoma. Design: Retrospective international multicenter study Methods: Analysis of 974 eyes (Xen, 359; Trab, 455; Tube 160) of 847 subjects that underwent standalone Xen45 gel stent (Xen, 87 % ab-interno), trabeculectomy (Trab) or tube shunt (Tube) surgery with 12 months of follow-up. The primary outcome was time for visual acuity (VA) to return to within five letters of pre-operative baseline. Results: The baseline glaucoma severity was significantly worse in the Tube group (mean deviation -10.4 vs -12.9 vs -14.4 dB in Xen vs Trab vs Tube, P < 0.001). The proportion of eyes that returned to within 5 letters of baseline VA at 12 months was 93.0 %, 88.6 % and 89.4 % respectively. Compared to the Trab group, the Xen had a significantly shorter median recovery time (9 vs 15 vs 15 days) and higher likelihood of return to baseline VA, including in a subcohort propensity score matched by baseline characteristics (OR 1.48, CI 1.18–1.87, P < 0.001). The Xen group however displayed lower surgical success than the Trab group. There was no significant difference in the rate of VA loss at 12 months (2.5 % vs 2.5 % vs 5 %, P = 0.21). Conclusions: Subconjunctival minimally invasive glaucoma surgery displayed the fastest and a higher likelihood of return to baseline visual acuity compared to Trab and Tube surgery.