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