Purpose: To apply propensity score matching to Ahmed glaucoma drainage implants (AGI) to trabectome-mediated ab interno trabeculectomy (AIT). Recent data suggests that AIT can produce results similar to AGI which is traditionally reserved for more severe glaucoma. Methods: AGI and AIT patients with at least one year of follow-up were included. The primary outcome measures were intraocular pressure (IOP), glaucoma medications, and a Glaucoma Index (GI) score. GI reflected glaucoma severity based

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... on visual field, the number of preoperative medications, and preoperative IOP. Score matching used a genetic algorithm consisting of age, gender, type of glaucoma, concurrent phacoemulsification, baseline number of medications, and baseline IOP. Patients without a close match were excluded. Results: Of 152 patients, 34 AIT patients were matched to 32 AGI patients. Baseline characteristics including ethnicity, IOP, the number of medications, glaucoma type, the degree of VF loss and GI were not significantly different between AIT and AGI. AIT had a preoperative IOP of 23.6±8.1 mmHg compared to 26.5+10.6 for AGI. At 12 months, the mean IOP was 15.0±9 mmHg for AIT versus 15.0±4 mmHg for AGI (p=0.8), while the number of drops was 2.3±2.2 for AIT versus 3.6±1.3 for AGI (p=0.016). Only 6 AIT patients (17.6%) required further surgery within the first 12 months versus 9 (28%) for AGI. Success, defined as IOP<21 mmHg, <20% reduction and no reoperation, was achieved in 76% of AIT versus 69% of AGI (p=0.48). Complications occurred in 13% of AGI and 0.8% of AIT. Conclusions: A propensity score matched comparison of AIT and AGI demonstrated an equivalent IOP reduction through one year. Surprisingly, the AGI group required more glaucoma medications than the AIT group at 6 and 12 months.