Ex-PRESS Implantation versus Trabeculectomy in Open-Angle Glaucoma: A Meta-Analysis of Randomized Controlled Clinical Trials

Abstract

ObjectiveTo evaluate the efficacy and safety of Ex-PRESS implantation (Ex-PRESS) compared to trabeculectomy in the treatment of patients with open-angle glaucoma (OAG).MethodsA comprehensive literature search using the Cochrane Methodology Register to identify randomized controlled clinical trials (RCCTs) comparing Ex-PRESS to trabeculectomy in patients with OAG. Efficacy estimates were measured by weighted mean difference (WMD) for the percentage intraocular pressure reduction (IOPR%) from baseline to end-point, and odds ratios (OR) for the complete success rate and postoperative interventions. Safety estimates were measured by OR for postoperative complications. Statistical analysis was performed using the RevMan 5.1 software.ResultsA total of four RCCTs were selected for this meta-analysis, including 215 eyes of 200 patients (110 eyes in the Ex-PRESS group, 105 eyes in the trabeculectomy group). There was no significant difference between Ex-PRESS and trabeculectomy in the IOPR% (WMD = 3.15; 95% confidence interval (CI), −6.17–12.47; P = 0.51). The pooled OR comparing Ex-PRESS to trabeculectomy for the complete success rate at one year after surgery were in favor of Ex-PRESS (OR = 2.93; 95% CI, 1.39–6.16; P = 0.005). The Ex-PRESS procedure was found to be associated with lower number of postoperative interventions (OR = 0.23; 95% CI, 0.07–0.81; P = 0.02) and with a significantly lower frequency of hyphema than trabeculectomy (OR = 0.21; 95% CI, 0.05–0.85; P = 0.03), whereas other complications did not differ statistically.ConclusionIn OAG, Ex-PRESS and trabeculectomy provided similar IOP control, but Ex-PRESS was more likely to achieve complete success, with fewer postoperative interventions. Complication rates were similar for the two types of surgery, except for a lower frequency of hyphema in the Ex-PRESS group.

Device modified trabeculectomy for glaucoma

“…When metaanalysis of outcomes is appropriate, pooling across studies should increase the power and yield valuable information. Authors of a few recently published articles have addressed the effectiveness and safety of the Ex-PRESS and Ologen devices (Chen 2014;He 2014;Wang 2013a). However, a comprehensive, rigorous systematic review in this area is warranted.…”

One Year of Glaucoma Research in Review—2013 to 2014

“…EX-PRESS implantation was associated with higher rates of complete operative success and fewer hyphemas compared with trabeculectomy. 63,64 Patel et al 65 also observed no significant different in success rates between the two operations but found the overall 1-year cost was significantly greater for EX-PRESS implantation, and the incremental cost-effectiveness ratio was $9625 (95% confidence interval, $2435-548,084).…”

“…Two meta-analyses 63,64 examined the efficacy and safety of EX-PRESS implantation compared with trabeculectomy for uncontrolled POAG (3 of the 4 randomized controlled trials included in each analysis were the same) and found the two interventions to have similar efficacy in IOP reduction. EX-PRESS implantation was associated with higher rates of complete operative success and fewer hyphemas compared with trabeculectomy.…”

Device-modified trabeculectomy for glaucoma

“…When meta-analysis of outcomes is appropriate, pooling across studies should increase the power and yield valuable information. Authors of a few recently published articles have addressed the effectiveness and safety of the Ex-PRESS and Ologen devices (Chen 2014; He 2014; Wang 2013a). However, a comprehensive, rigorous systematic review in this area is warranted.…”