Outcomes of Trabeculectomy and Glaucoma Drainage Device Surgery in Congenital Aniridia-Associated Glaucoma: A Systematic Review and Meta-Analysis

Abstract

Introduction This study aimed to compare the surgical outcomes of trabeculectomy and glaucoma drainage device (GDD) implantation in patients with congenital aniridia.

Methods Eligible studies were retrieved from Embase, MEDLINE (via PubMed), and the Cochrane Central Register of Controlled Trials (CENTRAL) up to December 15, 2024. Studies were included if they reported clinical outcomes following trabeculectomy or GDD implantation in individuals with aniridic glaucoma. Outcomes of interest included success rates, best spectacle-corrected visual acuity (BSCVA), intraocular pressure (IOP), use of glaucoma medications, and postoperative complications.

Data extraction and synthesis were conducted according to the Cochrane Handbook. Meta-analyses were performed using a random-effects model. Heterogeneity among studies was evaluated using the Q test and I2 statistic.

Results Twenty-two of the 1039 screened studies were included in the meta-analysis. Pooled complete success rates were not significantly different between trabeculectomy and GDD treatments (p = 0.88). However, the qualified success rate was significantly higher following GDDs compared to trabeculectomy (p < 0.001) in patients with aniridia. Cox frailty regression analysis of individual success data showed similar results: the hazard ratio of failure was significantly higher after trabeculectomy than after GDD (HR 5.684 from 1.46 to 22.14, p = 0.012). No significant differences were observed between the two procedures in terms of IOP reduction (p = 0.53), percentage change in IOP (p = 0.24), or reduction in glaucoma medications (p = 0.56) at final follow-up. Additionally, there was no significant difference in the change in BSCVA between the two groups (p = 0.72).

Conclusion Regarding complete success rates, trabeculectomy does not seem to provide a significant benefit over GDDs in treating aniridic glaucoma. However, the qualified success rate is greater with GDD implantation than with trabeculectomy. Both surgical approaches show similar effectiveness in lowering intraocular pressure, reducing the need for glaucoma medications, and maintaining visual acuity.