Phacotrabeculectomy versus Phaco with Implantation of the Ex-PRESS Device: Surgical and Refractive Outcomes-A Randomized Controlled Trial.

Zofia Mariak,Emil Saeed,Anna Byszewska,Marek Rękas,Joanna Konopińska

doi:10.3390/jcm10030424

Zofia Mariak, Emil Saeed + Show 3 more

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https://doi.org/10.3390/jcm10030424

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Abstract

The aim of this study was to compare surgical and refractive outcomes between phacotrabeculectomy (P-Trab) and phaco with Ex-PRESS (P-Ex-PRESS) for glaucoma at a 6-month follow-up. This prospective randomized controlled trial included 81 eyes; 43 eyes (53%) and 38 eyes (47%) were assigned to the P-Ex-PRESS and P-Trab groups, respectively. Refraction, intraocular pressure (IOP), and best-corrected visual acuity were measured. Refractive change was analyzed using the cylinder’s magnitude, and polar analysis assessed the change in the trend of astigmatism [with-the-rule, against-the-rule (ATR), oblique (OBL)], evaluating mean astigmatism in centroid form. All patients showed a statistically significant postoperative decrease in IOP (P < 0.05). There were no differences between the groups in terms of postoperative IOP and visual outcomes or in astigmatism preoperatively or postoperatively (P = 0.61, P = 0.74). In both groups, the mean preoperative and postoperative astigmatism were ATR and OBL, respectively. Preoperative and postoperative centroids in the P-Ex-PRESS group were 0.44 ± 1.32 D at 177° and 0.35 ± 1 D at 8°, respectively, (P = 0.5) and in the P-Trab group were 0.16 ± 1.5 D at 141° and 0.39 ± 1.38 D at 29°, respectively (P = 0.38). Both P-Ex-PRESS and P-Trab showed comparable antihypertensive efficacy in treating open-angle glaucoma over 6 months. Preoperative and postoperative astigmatism did not differ between groups. The groups showed comparable results for final visual acuity.

Highlights

Published: 22 January 2021Trabeculectomy and implantation of the Ex-PRESS mini device (Alcon Laboratories, Fort Worth, TX, USA) are anti-glaucoma procedures that improve subconjunctival outflow [1]
To the best of our knowledge, this is the first prospective study to compare P-Trab and combined phaco-Ex-PRESS device implantation based on surgically induced astigmatism (SIA) in glaucoma patients
Astigmatism was of the ATR type in the P-Ex-PRESS group, and the direction had not changed by the 6-month follow-up

Summary

Introduction

Published: 22 January 2021Trabeculectomy and implantation of the Ex-PRESS mini device (Alcon Laboratories, Fort Worth, TX, USA) are anti-glaucoma procedures that improve subconjunctival outflow [1]. Trabeculectomy remains the “gold standard” for anti-glaucoma surgery, implantation of the less-invasive Ex-PRESS mini seton is effective [2] Both procedures establish a new, alternative outflow route within the trabecular meshwork and evacuation of the aqueous humor via artificial filtering fistulae. They can be used as a standalone procedure or combined with phacoemulsification when patients have both glaucoma and cataract. Penetrating glaucoma procedures require extended ocular tissue interference, such as conjunctival preparation, scleral cutting, and suture application. They provide high hypotensive efficacy, and are reasonable treatments for moderate to advanced glaucoma, eliminating the chronic need for intraocular pressure (IOP)-lowering eye drops

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