Abstract
ABSTRACTAim To compare the efficacy and safety of Ex-PRESS glaucoma filtration surgery to trabeculectomy in African origin patients.Materials and methods A retrospective chart review was performed on 56 African American patients undergoing Ex-PRESS glaucoma shunt (E) or trabeculectomy (T) between 2004 and 2012. Data collected included intraocular pressure (IOP) and glaucoma medication use at baseline and postoperative week 1, Month (M) 1, M3, M6, M12. Postoperative interventions including laser suture lysis (LSL) and 5FU injections were analyzed. Complete and qualified success rate, and eyes failing and requiring more surgery were determined. Means, SD, chi-square, and Student’s t-test were performed.Results A total of 56 subjects (E 28, T 28) were included in the analysis. There was a statistically significant reduction (p < 0.05) in IOP and number of glaucoma medications at all time points compared to baseline for both groups. Extent of IOP reduction between groups was not statistically significant at any time point, except postoperative week 1. Mean number of glaucoma medications between groups was not significant, except at 3 months (lower in EXP group). The cumulative number of postoperative interventions within 3 months (LSL and 5-FU) was significantly greater for the TRAB than EXP (3.89 ± 2.4 vs 2.36 ± 2.2, p = 0.007). Success rates were comparable between both groups (Table 2).Conclusion Our study is unique in patients of African origin showing statistical significance in the requirement of less postoperative 5-FU injections during the first 3 months following surgery in the Ex-PRESS group vs the trabeculectomy group. The Ex-PRESS shunt was as effective as trabeculectomy in reducing IOP and use of glaucoma medications up to 1 year.Clinical significance The possible benefit of this article is to help guiding ophthalmologists to select the type of glaucoma filtration surgery to undergo in an African American patient with glaucoma.How to cite this article Bustros YD, Fechtner R, Khouri AS. Outcomes of Ex-PRESS and Trabeculectomy in a Glaucoma Population of African Origin: One Year Results. J Curr Glaucoma Pract 2017;11(2):42-47.
Highlights
Glaucoma is a disease of the optic nerve that can cause permanent visual loss.[1]
The Ex-PRESS shunt was as effective as trabeculectomy in reducing intraocular pressure (IOP) and use of glaucoma medications up to 1 year
Clinical significance: The possible benefit of this article is to help guiding ophthalmologists to select the type of glaucoma filtration surgery to undergo in an African American patient with glaucoma
Summary
Glaucoma is a disease of the optic nerve that can cause permanent visual loss.[1]. A recent systematic review and metanalysis estimated the current number of people with glaucoma to be 64.3 million and is expected to increase to 76.0 million in 2020 and 111.8 million in 2040.2 Glaucoma has a younger age at onset in black patients. Trabeculectomy (T), which is a guarded filtration procedure whereby a fistula is created to drain the aqueous humor from the anterior chamber, remains the gold standard surgical method for reduction of IOP in glaucoma patients.[5,6] A recent study done by Jampel et al showed complete success in 39% of cases and qualified success in 79%.7. Trabeculectomy is associated with multiple postoperative complications, such as hyphema, hypotony, choroidal detachment, suprachoroidal hemorrhage, and others.[8] The development of new techniques and devices in glaucoma surgery aiming to achieve the desired lower levels of IOP with less complications remains important. The Ex-PRESS shunt is a stainless steel device, i.e., implanted in the eye to drain the aqueous humor under a scleral flap forming a filtering bleb
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