Evaluation of Ex-PRESS Mini Glaucoma Shunt Implantation with Preoperative Intracameral Bevacizumab Injection in Refractory Neovascular Glaucoma

Yılmaz, Suzan Güven; Yıldırım, Şeyda; Değirmenci, Cumali; Ateş, Halil

doi:10.5301/ejo.5000763

Cited by 8 publications

(5 citation statements)

References 28 publications

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“… 6 – 10 One study showed that EX-PRESS implantation combined with preoperative bevacizumab injection might be effective in patients with NVG; however, that study suffered from the limitations of a small sample size and lack of a control group. 11 The EX-PRESS glaucoma filtration device versus trabeculectomy (XVT) study, 8 which excluded patients with NVG, compared clinical outcomes of EX-PRESS implantation and trabeculectomy alone and found similar mean IOP, number of medications, and surgical success rates between the two groups. Moreover, the overall surgical complication rate was lower in the EX group than in the Trab group.…”

Section: Discussionmentioning

confidence: 99%

“… 6 – 10 However, subjects in most of the previous studies did not have NVG. Although a few reports showed that EX-PRESS implantation reduced IOP postoperatively in eyes with NVG, 11 , 12 its therapeutic effect in patients with NVG is not fully understood. To the best of our knowledge, there have been no reports comparing the effects of EX-PRESS implantation with those of trabeculectomy alone in patients with NVG.…”

Section: Introductionmentioning

confidence: 99%

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

Shinohara

Akiyama

Magori

et al. 2017

OPTH

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BackgroundThe 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.MethodsThe 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.ResultsThe 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).ConclusionImplantation 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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Shinohara

Akiyama

Magori

et al. 2017

OPTH

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“…We compared the 1 year surgical results of Ex-PRESS® mini shunt surgery with trabeculectomy for NVG patients. Since, past studies about the results of Ex-PRESS® mini shunt surgery for NVG included less than 10 patients [15, 16], or non-comparative one [17], this is the first report of such a comparison for NVG, and therefore should have important relevance to current clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of Ex-PRESS® mini shunt surgery versus trabeculectomy for neovascular glaucoma: a retrospective comparative study

et al. 2019

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BackgroundThe objective of this study is to evaluate and compare the short-term efficacy and safety of Ex-PRESS® mini shunt surgery and trabeculectomy for neovascular glaucoma (NVG).MethodsPatients with NVG who underwent Ex-PRESS® mini shunt surgery or trabeculectomy as a primary glaucoma surgery between March 2013 and October 2015 were included in the study, and their medical charts were retrospectively reviewed. The Ex-PRESS® and trabeculectomy groups included 14 eyes and 30 eyes, respectively. Surgical failure was defined by an intraocular pressure (IOP) of ≥21 mmHg (condition A) or ≥ 18 mmHg (condition B); Kaplan–Meier survival analyses and the multivariable Cox proportional hazards model were used to assess efficacies.ResultsKaplan–Meier survival analyses indicated that the probabilities of success at 1 year for the Ex-PRESS® group were 25.7 and 31.8% based on complete and qualified success under condition A, respectively. The corresponding values for the trabeculectomy group were 47.8 and 69.3%, and there was a significant difference in qualified success with condition A (Fig. 1; P = 0.018), while there were no significant differences in the other criteria. Ex-PRESS® mini shunt surgery and higher intraocular pressure were independent prognostic factors using Cox proportional hazards model analyses in qualified success as in condition A (P = 0.012 and 0.0495, respectively). The occurrences of postsurgical hyphema and bleb leaks were significantly higher in the trabeculectomy group (P = 0.005 and 0.008, respectively).ConclusionDuring a 1 year follow-up, Ex-PRESS® mini shunt surgery was a less effective, but safer treatment for NVG compared with trabeculectomy.

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“…All the studies in this meta-analysis used intravitreal injections, but other approaches such as subconjunctival and anterior chamber injections are also used clinically. Guven Yilmaz et al 42 reported that drainage valve implantation with preoperative anti-VEGF anterior chamber injection may be an effective alternative for refractory NVG. Bhagat et al 43 found that intracameral injection was the most effective for IOP control.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Outcomes of Trabeculectomy With or Without Anti-VEGF in Patients With Neovascular Glaucoma: A Systematic Review and Meta-Analysis

Zhou,

Chen,

Luo

et al. 2023

Trans. Vis. Sci. Tech.

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Objectives The aim of this study was to compare the safety and efficacy of trabeculectomy alone or combined with intravitreal injections of anti–vascular endothelial growth factor (anti-VEGF) agents for the treatment of neovascular glaucoma. Methods We conducted a systematic review and meta-analysis to compare the effects of trabeculectomy alone or combined with intravitreal injections of anti-VEGF agents for the treatment of neovascular glaucoma. We searched four databases (PubMed, Cochrane Library, Embase, and Web of Science) up to January 2023 and extracted data on three surgical outcomes: postoperative intraocular pressure, success rate and complications. We used a random-effects model to calculate pooled relative risk (RR) or standardized mean difference (SMD) estimates and 95% confidence intervals (CIs). We assessed publication bias using Begg and Egger tests. Results We included seven studies with 353 eyes. Compared to trabeculectomy alone, trabeculectomy with anti-VEGF had a lower risk of postoperative complications (RR, 0.60; 95% CI, 0.41–0.89) and higher success rate (RR, 1.19; 95% CI, 1.02–1.40). The intraocular pressure reduction was significantly greater in the trabeculectomy with anti-VEGF augmentation group than the trabeculectomy group from 1 week (SMD, −1.36; 95% CI, −2.76 to 0.04) to 6 months (SMD, −0.79; 95% CI, −1.50 to −0.07) after surgery. Conclusions According to current evidence, adding intravitreal injection of anti-VEGF agents to trabeculectomy may improve the short time outcomes of patients with neovascular glaucoma.

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Evaluation of Ex-PRESS Mini Glaucoma Shunt Implantation with Preoperative Intracameral Bevacizumab Injection in Refractory Neovascular Glaucoma

Abstract: Ex-PRESS mini glaucoma shunt implantation with preoperative bevacizumab injection may be an effective alternative procedure for refractory neovascular glaucoma.

Cited by 8 publications

References 28 publications

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

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

Efficacy and safety of Ex-PRESS® mini shunt surgery versus trabeculectomy for neovascular glaucoma: a retrospective comparative study

Short-Term Outcomes of Trabeculectomy With or Without Anti-VEGF in Patients With Neovascular Glaucoma: A Systematic Review and Meta-Analysis

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