Abstract
Purpose Accumulating studies comparing the efficacy and safety of trabeculectomy and EX-PRESS implantation in open-angle glaucoma (OAG) report inconsistent findings. Thus, we conducted the updated meta-analysis to clarify the issue. Methods Randomized controlled trials (RCTs) were selected through search of databases PubMed, Web of Science, Embase, and the Cochrane Library from their inception up until November 2018. The pooled mean difference (MD) for intraocular pressure reduction (IOPR) and antiglaucoma medication reduction, odds ratio (OR) for operative success, complication, and postoperative intervention was calculated using the random effects model. Results 8 RCTs were enrolled, including 223 eyes in the EX-PRESS group and 217 eyes in the trabeculectomy group. EX-PRESS device implantation had a better IOPR% at 12 months postoperatively (MD = 8.9, 95% confidence interval (CI) = 2.5–15.3, P=0.006). There was no statistically significant difference in the antiglaucoma medication reduction (MD = 6.01, 95% CI = −4.13–16.15, P=0.25) and qualified success (P > 0.05). Statistically higher complete success at 1 year postoperatively was found in the EX-PRESS group (OR = 3.26, 95% CI = 1.24–8.55, P=0.02). EX-PRESS was associated with a lower frequency of increased IOP (OR = 0.15, 95% CI = 0.03–0.93, P=0.04) and hyphema (OR = 0.20, 95% CI = 0.05–0.74, P=0.02). Less postoperative intervention was needed in the EX-PRESS group (OR = 0.43, 95% CI = 0.20–0.94, P=0.04). Conclusion For OAG patients, EX-PRESS implantation provided better efficacy in IOP control and complete success at 1 year postoperatively, with fewer increased IOP and hyphema as well as postoperative interventions. EX-PRESS device and trabeculectomy were similar in the qualified success and antiglaucoma medication reduction.
Highlights
Glaucoma is the leading cause of irreversible blindness worldwide
Two meta-analyses of 4 randomized controlled trials (RCTs) were performed in 2014, and the results showed that both methods provided similar intraocular pressure (IOP) control, but the complete operative success was favorable to Ex-PRESS [19, 20]
The abstracts of the remaining studies were inspected, and 49 articles with possibly relevant trials were further identified in full texts. 8 articles were from three cohorts, respectively [5, 7, 9, 12, 13, 15,16,17], so the most recent three articles were chosen. us, 8 RCTs were eligible after a full-text screening [6, 8,9,10,11,12,13,14] and were included in the metaanalysis
Summary
Glaucoma is the leading cause of irreversible blindness worldwide. It is estimated that 6.7 million people will be affected by open-angle glaucoma (OAG) in 2020 [1]. Articles were considered qualified if they fulfilled the following inclusion criteria: (1) participants: OAG patients who could not be controlled with the maximum antiglaucoma medicine; (2) intervention: trabeculectomy versus EX-PRESS implantation; (3) outcomes: at least one of the outcomes of interest discussed below was involved; (4) follow-up time: at least 6 months postoperatively; and (5) publication type: RCT. E authors reviewed the studies and allocated a score of “high,” “low,” or “unclear” to the following items: (1) selection bias (sufficient generation of the randomization sequence and allocation concealment?); (2) performance and detection bias (blinding of personnel, participants, and outcome assessors?); (3) attrition bias (incomplete outcome data and how to deal with this?); (4) reporting bias (evidence of reporting outcome selectively?); and (5) other sources of bias (any other potential threats to validity?). Begg’s and Egger’s measures should be calculated
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