Modified CO2 Laser-assisted Deep Sclerectomy Compared With Conventional Tabeculectomy in Chinese Primary Open-angle Glaucoma

Abstract Purpose: To evaluate the efficacy and safety of modified CO2 laser-assisted sclerectomy surgery (MCLASS) compared with conventional trabeculectomy (TRAB) in medically uncontrolled Chinese primary open-angle glaucoma (POAG) patients.Methods: A total of 87 patients were reviewed, including 45 in the MCLASS group and 42 in the TRAB group. Intraocular pressure (IOP), best corrected visual acuity (BCVA) and use of supplemental medical therapy were retrospectively compared at baseline and until 24 months postoperatively.Results: Patients in both groups achieved a significant IOP decrease from baseline (P < 0.001), and postoperative IOP in the MCLASS group was significantly lower than that of the TRAB group at 12 and 24 months. The reduction of medication was statistically significant in both groups, and the number of postoperative medications was significantly higher in the TRAB group at 12 and 24 months. At 12 and 24 months, the complete success rates were 60% and 53.3%, respectively, for MCLASS versus 66.7% and 59.5%, respectively, for TRAB; the qualified success rates were 91.1% and 88.9%, respectively, for MCLASS versus 83.3% and 80.9%, respectively, for TRAB. BCVA deterioration post-TRAB was clinically more serious than that of post-MCLASS at 12 and 24 months, respectively. However, there was no statistically significant difference between the two groups at any time point postoperatively. Compared with MCLASS, more complications occurred postoperatively in the TRAB group. Conclusion: MCLASS is an effective surgical option for Chinese POAG patients, showing success rate results comparable with TRAB while having greater IOP reduction, fewer medications and a lower risk of complications compared to TRAB up to 24 months.