Trabeculectomy and EX-PRESS Implantation in Open-Angle Glaucoma: An Updated Meta-Analysis of Randomized Controlled Trials

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.

Prognosis of Postoperative Progression of Glaucoma Optic Neuropathy at Primary Open-Angle Glaucoma

“…Therefore, the search for new informative markers and forecasting methods progression of glaucoma optic neuropathy (GON) is relevant today problem [7,8]. Our previous research has established the effectiveness of the use of trabeculectomy (TE) for the surgical treatment of POAG with implantation of the Ex-Press shunt [9], which coincides with the data of the latter meta-analysis [10].…”

“…At first glance, this contradicts the classical notion of the importance of high IOP for the development of GON [5]. But it is known that postoperative hypotension has a negative effect on the progression of IOP and excessive reduction of IOP after surgery for POAG worsens the long-term results of surgical treatment [9][10][11]. Our results confirm this opinion -the decrease IOP after surgery has a significant effect on the progression of GON after one year (p = 0.012).…”

“…The stage of the disease was determined by classification perimetric changes of glaucoma [5,8]. Patients underwent trabeculectomy (TE) with Ex-Press shunt implantation [10]. The operations were performed under local anaesthesia by one team of surgeons.…”

Маркеры Апоптоза И Прогрессирования Глаукомной Оптической Нейропатии После Хирургического Лечения Первичной Открытоугольной Глаукомы

“…Враховуючи дані про зниження ВОТ після хірургічного лікування й негативний вплив післяопераційної гіпотонії [1,8,14] Стадію захворювання визначали за класифікацією периметричних змін глаукоми [1,17]. Пацієнтам виконували трабекулектомію з імплантацією шунта Ex-Press [18]. Операції були виконані під місцевою анестезією однією бригадою хірургів.…”

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“…Most trials comparing the efficacy of both procedures, showed equivalent efficacy in heterogeneous groups consisting of phakic and pseudophakic patients [6,7,[10][11][12][13][14][15]. Several meta-analyses comparing Ex-PRESS surgery to standard trabeculectomy showed that the Ex-PRESS surgery is more likely to achieve complete success, with fewer postoperative interventions and possibly a lower frequency of complications such as hypotony [4,16,17].…”