Trabeculectomy Versus EX-PRESS Shunt Versus Ahmed Valve Implant: Short-term Effects on Corneal Endothelial Cells

Casini, Giovanni; Loiudice, Pasquale; Pellegrini, Marco; Sframeli, Angela Tindara; Martinelli, Paolo; Passani, Andrea; Nardi, Marco

doi:10.1016/j.ajo.2015.08.022

Cited by 45 publications

(50 citation statements)

References 26 publications

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“…To ensure maintenance of the corneal integrity and transparency, the corneal endothelium is essential [ 15 ]. Aging, surgery, and trauma have been reported by several studies to be able to reduce the CECD [ 2 , 4 , 12 – 14 ]. Our current study showed that while there were no changes in the CECD after the EX-PRESS implantation, there were significant decreases observed in the CECD after the trabeculectomies.…”

Section: Discussionmentioning

confidence: 99%

“…Since there was no effect on the CECD after the EX-PRESS shunt implantation without cataract surgery, this suggests that the cataract surgery may be responsible for these changes. Casini et al also found that there were no changes in the CECD at 1 or 3 months after the EX-PRESS shunt implantation surgery [ 12 ]. In contrast, Ishida et al showed that there was a significant decreased in the CECD at 24 months after the EX-PRESS shunt implantation [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…This loss can be accelerated by several risk factors that include, surgery, argon laser iridotomy, and even glaucoma itself [ 3 – 9 ]. Although it has been previously shown that trabeculectomy can damage corneal endothelial cells [ 10 – 13 ], no changes have been observed in the CECD at either 1 or 3 months after EX-PRESS implantation surgery [ 12 ]. In contrast, Ishida et al reported finding significant decreases in the CECD at 24 months after EX-PRESS implantation [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Changes in corneal endothelial cells after trabeculectomy and EX-PRESS shunt: 2-year follow-up

et al. 2018

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BackgroundTo compare trabeculectomy and EX-PRESS device implantation procedures for treating glaucoma and evaluate changes in corneal endothelial cell density (CECD).MethodsThis study prospectively evaluated changes in the CECD in 60 eyes of 60 patients who underwent trabeculectomy and 50 eyes of 45 patients who underwent EX-PRESS device implantation. Baseline patient data recorded included age at surgery, sex, type of glaucoma medications, and lens status. Using a noncontact specular microscope, corneal specular microscopy was performed preoperatively at the central cornea and then at 6, 12, 18 and 24 months after surgery. CECD before and after surgery was compared using a paired t-test.ResultsThere was a significant decrease in the IOP and number of antiglaucoma medications in both groups after the surgery. The mean CECD in the trabeculectomy group was 2505 ± 280 cells/mm2 at baseline, while it was 2398 ± 274 cells/mm2 (P < 0.001), 2349 ± 323 cells/mm2 (P < 0.001), 2293 ± 325 cells/mm2 (P < 0.001), and 2277 ± 385 cells/mm2 (P = 0.003) at 6, 12, 18, and 24 months, respectively. However, the CECD in the EX-PRESS group was 2377 ± 389 cells/mm2 at baseline, while it was 2267 ± 409 cells/mm2 (P = 0.007), 2292 ± 452 cells/mm2 (P = 0.043), 2379 ± 375 cells/mm2 (P = 0.318), and 2317 ± 449 cells/mm2 (P = 0.274) at 6, 12, 18, and 24 months, respectively.ConclusionsAs compared to trabeculectomy, EX-PRESS device implantation appears to be a safer procedure with regard to the endothelial cell loss risk.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Changes in corneal endothelial cells after trabeculectomy and EX-PRESS shunt: 2-year follow-up

et al. 2018

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“…To our knowledge, however, there has been only one report that directly compared the effects of these two surgical procedures on CECD [18]. In addition, only short-term results at 3 months after AGV implantation and trabeculectomy were reported in that study.…”

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confidence: 99%

Changes in Corneal Endothelial Cell after Ahmed Glaucoma Valve Implantation and Trabeculectomy: 1-Year Follow-up

Kim

2016

Korean J Ophthalmol

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PurposeTo compare changes in corneal endothelial cell density (CECD) after Ahmed glaucoma valve (AGV) implantation and trabeculectomy.MethodsChanges in corneal endothelium in patients that underwent AGV implantation or trabeculectomy were prospectively evaluated. Corneal specular microscopy was performed at the central cornea using a non-contact specular microscope before surgery and 6 months and 12 months after surgery. The CECD, hexagonality of the endothelial cells, and the coefficient of variation of the cell areas were compared between the two groups.ResultsForty eyes of 40 patients with AGV implantation and 28 eyes of 28 patients with trabeculectomy were studied. Intraocular pressure in the AGV implantation group was significantly higher than that in the trabeculectomy group (p < 0.001), but there was no significant difference in other clinical variables between the two groups. In the AGV implantation group, the mean CECD significantly decreased by 9.4% at 6 months and 12.3% at 12 months compared with baseline values (both, p < 0.001), while it decreased by 1.9% at 6 months and 3.2% at 12 months in the trabeculectomy group (p = 0.027 and p = 0.015, respectively). The changes at 6 months and 12 months in the AGV implantation group were significantly higher than those in the trabeculectomy group (p = 0.030 and p = 0.027, respectively). In the AGV implantation group, there was a significant decrease in the CECD between baseline and 6 months and between 6 months and 12 months (p < 0.001 and p = 0.005, respectively). However, in the trabeculectomy group, a significant decrease was observed only between baseline and 6 months (p = 0.027).ConclusionsBoth the AGV implantation group and the trabeculectomy group showed statistically significant decreases in the CECD 1 year after surgery. The decrease in CECD in the AVG implantation group was greater and persisted longer than that in the trabeculectomy group.

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“…From 0.3% (Casini et al. ) cell loss at 3 months in the EX‐PRESS only procedure to 37.4% (Konopińska et al. ) cell loss at 12 months follow‐up after Phaco‐EX‐PRESS.…”

Section: Discussionmentioning

confidence: 99%

The EX‐PRESS glaucoma shunt versus nonpenetrating deep sclerectomy with Esnoper implant in combined surgery for open‐angle glaucoma: a prospective randomized study

Muñoz

Antón

Castany

et al. 2019

Acta Ophthalmologica

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Purpose To report 1‐year treatment outcomes of P50 EX‐PRESS implant versus nonpenetrating deep sclerectomy (NPDS) with Esnoper V2000 combined with phacoemulsification. Design Randomized, prospective and multicentre clinical trial. Methods Settings: Six clinical centres. Population: Patients 54–89 years of age without previous filtering surgery with cataract and glaucoma who required lower levels of intraocular pressure (IOP). Interventions: Phaco‐EX‐PRESS P50 or Phaco‐NPDS with Esnoper V2000, both groups with mitomycin C (0.2 mg/ml for 2 min). Main outcome measures: IOP, complete success rate (IOP: ≥6 and ≤18 mmHg), visual acuity, use of medical therapy and systematic assessment of complications and postoperative interventions. Results A total of 98 eyes were enrolled, including 50 in the EX‐PRESS group and 48 in the NPDS group. At 12 months, IOP (mean ± SD) was 13.9 ± 3.3 mmHg in EX‐PRESS group and 13.3 ± 3.6 mmHg in NPDS group (p = 0.38). Success rate was 75% and 80% in EX‐PRESS and NPDS groups, respectively (p = 0.53). The number of glaucoma medications (mean ± SD) was 0.2 ± 0.55 in EX‐PRESS group and 0.17 ± 0.44 in NPDS group (p = 1.00). The total number of complications was 66 in 35 subjects in EX‐PRESS group and 39 in 23 subjects in NPDS group (p = 0.02). The incidence of more than one complication was n = 13 (26%) versus n = 9 (18.8%) in EX‐PRESS and NPDS groups, respectively (p = 0.38). The total number of required postoperative interventions was 59 and 26 in EX‐PRESS and NPDS groups, respectively (p = 0.01). Visual acuity was similar in both groups at month 12 (p = 0.13). Surgical time (mean ± SD) was 52.6 ± 13.6 min in EX‐PRESS group and 63.3 ± 19.4 min in NPDS group (p = 0.01). Conclusion Phaco‐EX‐PRESS surgery had similar success rate compared to Phaco‐NPDS during 1 year of follow‐up. Both procedures were associated with similar IOP reduction and use of additional medical therapy at 12 months. EX‐PRESS surgery required more postoperative interventions and had more complications, but needed less surgical time compared to NPDS.

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Trabeculectomy Versus EX-PRESS Shunt Versus Ahmed Valve Implant: Short-term Effects on Corneal Endothelial Cells

Cited by 45 publications

References 26 publications

Changes in corneal endothelial cells after trabeculectomy and EX-PRESS shunt: 2-year follow-up

Changes in corneal endothelial cells after trabeculectomy and EX-PRESS shunt: 2-year follow-up

Changes in Corneal Endothelial Cell after Ahmed Glaucoma Valve Implantation and Trabeculectomy: 1-Year Follow-up

The EX‐PRESS glaucoma shunt versus nonpenetrating deep sclerectomy with Esnoper implant in combined surgery for open‐angle glaucoma: a prospective randomized study

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