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Short-term outcomes after EX-PRESS implantation versus trabeculectomy alone in patients with neovascular glaucoma

Authors Shinohara Y, Akiyama H, Magori M, Kishi S

Received 8 September 2017

Accepted for publication 16 November 2017

Published 14 December 2017 Volume 2017:11 Pages 2207—2213

DOI https://doi.org/10.2147/OPTH.S151200

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser


Yoichiro Shinohara, Hideo Akiyama, Mikiya Magori, Shoji Kishi

Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan

Background: The purpose of this study was to investigate postoperative clinical outcomes in patients with neovascular glaucoma (NVG) who underwent trabeculectomy or EX-PRESS implantation and to identify predictors of successful EX-PRESS implantation.
Methods: The study designed as a retrospective observational analysis and was set in a single tertiary center. Eighty-nine patients (89 eyes) with NVG, were treated using trabeculectomy alone (Trab group; n=39) or EX-PRESS implantation (EX group; n=50). All patients with a history of glaucoma surgery were excluded. The main outcome measures were postoperative intraocular pressure (IOP), visual acuity (VA), number of medications, complications, additional therapy, and success rate.
Results: The mean follow-up duration was 4.6 months in the Trab group and 4.2 months in the EX group. There was no significant difference in IOP between the groups except at 1-month follow-up (P=0.045). The number of patients with early postoperative hypotony, a shallow anterior chamber, hyphema, or anterior chamber irrigation was significantly lower in the EX group than in the Trab group (P=0.016, 0.008, 0.019, and 0.014, respectively). The other outcomes, ie, VA, number of medications, and success rate, were similar between the two groups. In the EX group, the success rate was significantly lower in 15 patients with a history of vitrectomy compared to that in 35 patients without a history of vitrectomy (P=0.047).
Conclusion: Implantation of an EX-PRESS device may be more effective and safer than trabeculectomy alone in patients with NVG. However, a history of vitrectomy may affect the surgical success rate when using EX-PRESS.

Keywords: trabeculectomy, EX-PRESS, neovascular glaucoma, surgery, tube shunt

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