Outcomes of Ex-PRESS and Trabeculectomy in a Glaucoma Population of African Origin: One Year Results

Abstract

Aim 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.

Cutting the subconjunctival fragment of the XEN gel implant during needling procedure

“…1 Despite the potential reduction of IOP following trabeculectomy with the use of antimetabolites, several visionthreatening complications may still occur, such as hypotony maculopathy, choroidal effusion, suprachoroidal hemorrhage, and bleb-related endophthalmitis. 1,2 The XEN gel implant, a hydrophilic, non-inflammatory, subconjunctival gelatin stent (XEN Gel Stent, Allergan, Dublin, USA), provides an ab interno approach to create a permanent channel from the anterior chamber to the subconjunctival space and is designed to avoid early postoperative hypotony. 3,4 The flexibility of the implant and its expansion upon hydration allow it to be tissue conforming and thus preventing the risk of extrusion and migration.…”

“…1 Despite the potential reduction of IOP following trabeculectomy with the use of antimetabolites, several vision-threatening complications may still occur, such as hypotony maculopathy, choroidal effusion, suprachoroidal hemorrhage, and bleb-related endophthalmitis. 1,2…”

Long-Term Changes in Corneal Endothelial Cell Density after Ex-PRESS Implantation: A Contralateral Eye Study

“…Regarding corneal endothelial cells, some studies have proven their safety [ 12 , 13 , 26 , 27 , 28 ]. Previous studies reported no significantly faster loss in endothelial cell counts after Ex-PRESS implantation compared with trabeculectomy [ 14 , 17 , 29 ]. While other studies reported that corneal endothelial cell density (CECD) was significantly decreased after Ex-PRESS implantation [ 29 , 30 , 31 , 32 , 33 ].…”

“…Compared with trabeculectomy, it has the advantages of reduced trauma, simple operation, and improved safety. Most studies proved that the Ex-PRESS implantation had an equivalent curative effect to trabeculectomy [ 14 , 15 , 16 , 17 , 18 , 19 , 20 ], even with more complete success [ 21 , 22 ]; however, some literature argued that it was less effective than trabeculectomy [ 23 , 24 , 25 ]. Regarding corneal endothelial cells, some studies have proven their safety [ 12 , 13 , 26 , 27 , 28 ].…”

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

“…By contrast, in the case of neovascular glaucoma, standard trabeculectomy proved better performances as compared to Ex-PRESS. Ex-PRESS shunt interventions differ from one study to another, in terms of what and how frequently, but all patients received mitomycin C as anti-mitotic medication (Table I) [17][18][19][20][21][22][23][24][25][26][27].…”