Comparison of Trabeculectomy With Ex-PRESS Miniature Glaucoma Device Implanted Under Scleral Flap

Abstract

The Ex-PRESS implant under a scleral flap had similar IOP-lowering efficacy with a lower rate of early hypotony compared with trabeculectomy.

Long-term outcomes and risk factors for failure with the EX-press glaucoma drainage device

“…Furthermore, EX-PRESS implantation induces less inflammation than standard trabeculectomy because it does not involve tissue removal such as sclerectomy and iridectomy, thus reducing failure rate. 4,8,9,12,19,20,[23][24][25] Similarly, age and glaucoma type were not found to be statistically significant risk factors for failure in our study most probably because of the lesser inflammation induced by EX-PRESS implantation compared with standard trabeculectomy.…”

“…Our longterm outcomes are similar to the previous short-and mid-term results reported earlier. 1,3,4,[8][9][10][11][12][13][16][17][18][19][20][23][24][25] The complete success rate in our study shows a decline from 83% at 1 year to 57% at 5 years. In a similar manner, de Jong et al 20 report on a complete success rate decline from 86.8% at 1 year to 59% at 5 years with the EX-PRESS.…”

“…During the past 5 years, numerous studies comparing the EX-PRESS with trabeculectomy reported that the EX-PRESS offers similar IOP control, lower complications rate, and higher complete success rates. 4,8,9,12,19,20,[23][24][25] These reports first included retrospective non-randomized studies, 4,13,19,23,25 and later on, prospective randomized studies. 9,12,20,24 Our study reports on 248 consecutive EX-PRESS implantations under a scleral flap over a period of 9 years with a maximum follow-up of 7 years.…”

“…Furthermore, retrospective non-randomized and prospective randomized studies compared it favourably with trabeculectomy. 4,8,9,12,19,20,[23][24][25] The majority of these reports are short-to medium-term studies with relatively small cohorts of patients. To date, there are no long-term studies on larger groups of patients that include statistical analysis on the risk factors for failure with the EX-PRESS.…”

Ex-PRESS outcomes using mitomycin-C, Ologen alone, Ologen with 5-fluorouracil

“…The primary advantages of the Ex-PRESS shunt are the ease with which it is inserted and the decreased need for a peripheral iridectomy. The Ex-PRESS implant has been shown to have similar intraocular pressure (IOP)-lowering effect as standard trabeculectomy with a lower rate of early postoperative hypotony [1]. Adjunctive use of agents such as transient application of mitomycin C (MMC) and 5-fluorouracil (5-FU) has been shown to significantly improve long-term success for standard trabeculectomy and decreases dependence on anti-glaucoma medications [2].…”