Comparison of Ex-PRESS P-200 mini-shunt implantation and standard trabeculectomy for open-angle glaucoma: four-year follow-up

Abstract

Introduction: The study aimed to evaluate the efficacy and safety in 4-year follow-up of ExPRESS P-200 mini-shunt implantation versus standard trabeculectomy. Material and methods: A single-center retrospective study on patients diagnosed with open-angle glaucoma with failed medical treatment and who underwent ExPRESS device implantation or standard trabeculectomy was conducted. Seventy-three eyes were included in the analysis, 33 with ExPRESS P-200 implantation and 40 with standard trabeculectomy. Results: Significant decreases in the intraocular pressure (IOP) were observed after surgery and at all follow-ups in both groups (p < 0.001) with no significant difference between the two groups (p > 0.40). No significant differences with regard to post-operative medications were observed (p > 0.10). Excepting the 3-year follow-up, when just a borderline significant difference regarding the visual acuity between the ExPRESS and standard trabeculectomy group was observed (p = 0.0504), the ExPRESS groups showed significantly better visual acuity at 6 weeks (p = 0.0324), 1 year (p = 0.0168), 2 years (p = 0.0162), and 4 years (p = 0.0111). Hypotony occurred more frequently among the ExPRESS group, while cataract occurred more frequently among those with standard trabeculectomy, without significant differences between groups (p > 0.09). No difference in hazard of failure was observed between interventions (HR = 0.72, p = 0.523). Conclusions: Both procedures provided good control of IOP and decreased the number of postoperative medications. The advantage of the ExPRESS shunt is the better visual acuity, but its main limitation is the cost.

Application of EX-PRESS implants type P-50 in the surgical treatment of open angle glaucoma in pseudophakic eyes

“…Furthermore, a faster return of postoperative visual acuity to preoperative values was observed in the eyes after EX-PRESS implantation than after trabeculectomy [3], which may increase patient satisfaction with the procedure. Similarly, satisfactory reduction of IOP was confirmed by other surgeons using EX-PRESS type P-50 [21][22][23][24] or P-200 [5,[25][26][27], but in some studies the EX-PRESS implant was less effective than trabeculectomy [28] or its implantation had higher reoperation rates [29]. The main risk factors for failure found in the literature are diabetes, non-Caucasian race, and previous glaucoma surgery [30].…”