Standard Trabeculectomy and Ex-PRESS Miniature Glaucoma Shunt

Abstract

Purpose:The aim of this study was to compare the efficacy and safety between standard trabeculectomy and the Ex-PRESS shunt implantation.Methods:A retrospective review of the records of 100 eyes of 100 patients who underwent trabeculectomy or Ex-PRESS shunt implantation between July 2010 and June 2012 was conducted. Of these, 61 (61%) eyes underwent trabeculectomy and 39 (39%) eyes underwent Ex-PRESS shunt implantation. Demographic information, glaucoma type, surgical details, preoperative, and postoperative data including intraocular pressure (IOP), number of medications, reoperation, and occurrence of any complications were recorded.Results:No differences in IOP reduction or number of postoperative IOP-lowering medications were demonstrated between the 2 procedures. Success rates were 86.9% for trabeculectomy and 84.6% for Ex-PRESS shunt. Rates of failure and hypotony were not significantly different between the groups. No parameter was correlated with success or failure of any procedure.Conclusions:Standard trabeculectomy and Ex-PRESS shunt have similar efficacy and safety profiles. As the Ex-PRESS shunt is considerably more expensive, its use may be unjustified, especially as a primary procedure.

Comparison of trabeculectomy versus Ex-PRESS: 3-year follow-up

“…Other authors have reported similar results to our present study in retrospective comparative studies, showing no statistically significant difference in success rates between Ex-PRESS and trabeculectomy 4 9 11 12. One study by Good and Kahook,3 with a mean follow-up of 28 months, found similar complete success rates in the Ex-PRESS versus trabeculectomy group, respectively, but interestingly found lower mean IOP in the trabeculectomy group.…”

“…Similar to other reports this difference was not statistically significant 3 6 11. Three studies reported more surgical interventions following trabeculectomy than after Ex-PRESS implantation,7–9 but only Dahan et al 8 found this difference to be statistically significant (p=0.0009).…”

Device-modified trabeculectomy for glaucoma

“…A retrospective comparative series by Maris 2007 of 100 eyes, Good 2011 of 70 eyes, and Moisseiev 2015 of 200 eyes did not find a significant difference between Ex-PRESS and trabeculectomy in lowering IOP. A retrospective review by Marzette 2011 of 153 eyes showed a lower risk of postoperative hypotony and a greater but statistically nonsignificant decrease in IOP with Ex-PRESS.…”

Surgical Management of Pseudoexfoliation Glaucoma

“…However, a recent retrospective study comparing ExPRESS to standard trabeculectomy in POAG, PXFG, and ''complex'' glaucomas found no difference between the 2 procedures in terms of surgical success, need for postoperative glaucoma medications, or complications between the different glaucoma subtypes. 49 Although the current evidence suggests equivalent efficacy between ExPRESS and standard trabeculectomy, well-designed studies providing evidence-based comparisons of the 2 procedures are lacking. 50 Moreover, studies evaluating the financial cost of the ExPRESS have underscored the fact that this procedure is substantially more expensive with a disposable item cost that is 3.5 times higher than standard trabeculectomy.…”