Comparison of trabeculectomy with Ex-PRESS shunt implantation in primary-open-angle-glaucoma patients: A retrospective study

Abstract

PurposeTo investigate the efficacy of intraocular pressure (IOP) control and medication use over time after trabeculectomy (TRBC) and Ex-PRESS shunt implantation in primary-open-angle-glaucoma (POAG) patients. DesignRetrospective case series. Patients and methodsA total of 33 unilateral POAG patients were enrolled, and 17 patients received traditional TRBC and 16 patients received Ex-PRESS device implantation. Data on IOP, reduction of antiglaucoma medication, and major complications were collected and analyzed after 12 months of follow up. ResultsAfter 12 months of follow up, both groups showed good IOP control. The mean preoperative IOP decreased from 38.5 (±6.9) to 18.2 (±11) mmHg after TRBC, and from 38.5 (±9.1) to 19.53 (±12.36) mmHg after Ex-PRESS implantation (both p < 0.05). The mean number of antiglaucoma medications prescribed at the last follow up decreased from 3.2 (±0.5) preoperatively to 1.2 (±1.4) after TRBC versus 3.3 (±0.7) preoperatively to 1 (±0.9) after Ex-PRESS implantation (both p < 0.05). Complete success rate (defined as no medication after surgery with IOP >5 and <18 mmHg) and qualified success rate (defined as with or without medication after surgery with IOP >5 and <18 mmHg) were similar (47% vs. 43% and 76.47% vs. 75%) between the two groups without statistical difference (p > 0.05). However, postoperative hypotony rate was more frequent after Ex-PRESS (37.5%) than after TRBC (17.64%). DiscussionTRBC and Ex-PRESS implantation provided similar IOP control and reduction of postoperative medication with low incidence of postoperative complications at intermediate-term follow up. However, the Ex-PRESS implantation device may last longer but with extra costs. It is up to the surgeon to decide which procedure to use according to the patient's situation and economic circumstances.