Abstract
PurposeTo evaluate the efficacy and safety of EX-PRESS implantation compared with trabeculectomy for uncontrolled open-angle glaucoma.MethodsPertinent randomized controlled trials were identified through systematic searches of the PubMed, EMBASE, and Cochrane Library. The efficacy measures utilized were the weighted mean differences (WMDs) for the intraocular pressure reduction (IOPR), the reduction in glaucoma medications, the change of visual acuity, and the relative risks (RRs) for operative success rates. The safety measures utilized were RRs for postoperative complications. The pooled effects were calculated using the random-effects model.ResultsFour randomized controlled trials of 292 eyes were included in this meta-analysis. The WMDs of the IOPR comparing the EX-PRESS with trabeculectomy were −0.25 (95% Cl: −3.61 to 3.11) at 6 month, 0.053 (−4.31 to 4.42) at 12 months, 0.81 (−4.06 to 5.67) at 24 months, and 0.20 (−2.11 to 2.51) at final follow-up. There was no statistically significance for IOPR at any point after surgery. There were also no significant differences in the reduction in glaucoma medications or visual acuity between the groups. The pooled relative risks comparing EX-PRESS with Trabeculectomy were 1.36 (1.11 to 1.66) for the complete operative success rate and 1.05 (0.94 to 1.17) for the qualified operative success rate. EX-PRESS and Trabeculectomy were associated with similar incidences in most complications with the exception of hyphema, with pooled RR being 0.18 (0.046 to 0.66).ConclusionsEX-PRESS implantation and trabeculectomy have similar efficacy in IOP-lowering, medication reduction, vision recovery, and qualified operative success rates. EX-PRESS associated with higher rates of complete operative success and fewer hyphema than with Trabeculectomy. However, these should be interpreted with caution because of the inherent limitations of the included studies.
Highlights
The EX-PRESS implant, one of the newest modifications in glaucoma filtration surgery, is a nonvalved stainless steel tube currently available in 3 models (X, P, and R models) and is already approved and widely used in Europe, the US, and Japan [1]. It was inserted at the limbus directly under the conjunctiva to connect the anterior chamber space directly to the subconjunctival space. This procedure was associated with high hypotony rates and erosion of the device through the conjunctiva, which led to the current technique of implantation under a partial thickness sclera flap, providing resistance to aqueous outflow and reducing the risk for conjunctival erosion [2]
We conducted a first metaanalysis of 2 randomized controlled trials (RCTs) and 6 nonrandomized comparative studies, and the results showed that EXPRESS was associated with equivalent efficacy to Trabeculectomy in lowering IOP [16]
Our objective was to perform a meta-analysis on RCTs comparing EX-PRESS and Trabeculectomy in the treatment of uncontrolled open-angle glaucoma (OAG)
Summary
The EX-PRESS implant, one of the newest modifications in glaucoma filtration surgery, is a nonvalved stainless steel tube currently available in 3 models (X, P, and R models) and is already approved and widely used in Europe, the US, and Japan [1]. It was inserted at the limbus directly under the conjunctiva to connect the anterior chamber space directly to the subconjunctival space. There were comparable proportions of patients who reached the IOP target with EX-PRESS and Trabeculectomy [16] These results have not been supported by 2 new RCTs [7,8]. Our objective was to perform a meta-analysis on RCTs comparing EX-PRESS and Trabeculectomy in the treatment of uncontrolled open-angle glaucoma (OAG)
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