Primary studies included in this systematic review

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Primary study

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Comparison of trabeculectomy and Ex-PRESS implantation in fellow eyes of the same patient: a prospective, randomised study.

Authors Dahan E , Ben Simon GJ , Lafuma A
Journal Eye (London, England)
Year 2012
Links Pubmed DOI PubMed Central

This article is included in 7 Systematic reviews Systematic reviews (7 references)

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<b>PURPOSE: </b>To compare intraocular pressure (IOP) over time after standard trabeculectomy vs Ex-PRESS implantation in patients with bilateral primary open-angle glaucoma (POAG).<b>DESIGN: </b>Prospective, randomised study.<b>Patients and METHODS: </b>This study included adult patients with bilateral POAG necessitating surgery. Each patient underwent trabeculectomy in one eye and Ex-PRESS implantation under a scleral flap in the other eye according to randomised contralateral allocations. Efficacy was assessed by IOP values and success rates (IOP threshold and/or need for topical glaucoma medication) during 30 months. Statistical analysis included Generalised Estimate Equation and Cox Survival models, and paired t-tests.<b>RESULTS: </b>Thirty eyes of 15 patients were studied for a mean of 23.6 months (SD, ± 6.9). At the last follow-up visit, mean pre-operative IOP decreased from 31.1 (± 14.2) to 16.2 (± 1.5) mm Hg after trabeculectomy, and from 28.1 (± 9.0) to 15.7 (± 1.8) mm Hg after Ex-PRESS implantation (P=0.001). The mean number of anti-glaucoma medicines prescribed at the last follow-up decreased from 3.7 pre-operatively (both groups) to 0.9 after trabeculectomy vs 0.3 after Ex-PRESS implantation (P=0.001). Complete success rates (5&lt;IOP&lt;18 mm Hg without medications) were higher with Ex-PRESS compared with trabeculectomy (P=0.0024). Postoperative complications were more frequent after trabeculectomy (33%) compared with Ex-PRESS (20%), with four trabeculectomy eyes (27%) needing postoperative interventions, compared with none with Ex-PRESS.<b>CONCLUSIONS: </b>Trabeculectomy and Ex-PRESS implantation provided similar IOP control, but the Ex-PRESS group had a lower rate of complications, fewer postoperative interventions, and needed less glaucoma medications.

Primary study

Unclassified

Resident-performed Ex-PRESS shunt implantation versus trabeculectomy.

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Journal Journal of glaucoma
Year 2012
Links Pubmed DOI

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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PURPOSE: To compare outcomes between resident-performed trabeculectomy and Ex-PRESS shunt implantation. METHODS: A consecutive cohort of 36 Ex-PRESS shunt implantations and 57 trabeculectomies (1 eye/patient) performed by resident surgeons in their third year of ophthalmic training at the University of California, San Francisco and at the San Francisco Veterans Administration Hospital, under the supervision of a single glaucoma fellowship-trained surgeon were included in this study. Eyes with < 6 months of follow-up or previous glaucoma surgery were excluded. Preoperative and postoperative intraocular pressure (IOP), preoperative and postoperative number of ocular antihypertensive medications and complication rates were compared between the 2 procedures retrospectively. RESULTS: No difference was found in postoperative IOP (all, P≥0.099) or proportional decrease in IOP (all, P≥0.092) between the trabeculectomy and Ex-PRESS shunt groups at all follow-up points. On average, the Ex-PRESS shunt group required significantly less ocular antihypertensive medication to control IOP at 3 months postoperative (P=0.01), but no difference was found at 6 months or 1 year (all, P≥0.28). A larger proportion of Ex-PRESS shunt patients had good IOP control without medication at 3 (P=0.057) and 6 months (P=0.076) postoperatively. No difference was found in the rates of sight-threatening complications between groups (all, P≥0.22). CONCLUSIONS: In the hands of ophthalmology residents in their third year of training, the trabeculectomy and Ex-PRESS shunt implantation procedures perform comparably in terms of postoperative IOP control, reduction in patient dependence on ocular antihypertensive medications, and risk of complication in our population.

Primary study

Unclassified

The first report on intermediate-term outcome of Ex-PRESS glaucoma filtration device implanted under scleral flap in Japanese patients.

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Journal Clinical ophthalmology (Auckland, N.Z.)
Year 2011
Links Pubmed DOI PubMed Central

This article is included in 3 Systematic reviews Systematic reviews (3 references)

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PURPOSE: This paper compares the outcomes of the Ex-PRESS(®) Glaucoma Filtration Device (Alcon, Fort Worth, TX) implant observed in Japanese patients for 1 year with those of patients undergoing trabeculectomy. PATIENTS AND METHODS: The subjects comprised ten eyes of ten cases with open-angle glaucoma for which filtration surgery using Ex-PRESS (P-50) was performed by one operator from February 2008 and observed for at least 1 year (Ex-PRESS Group), and eleven eyes of eleven cases for which trabeculectomy was performed by the same operator (TE Group). For both groups, mitomycin C was used and a scleral flap was created after a fornix-based incision of the conjunctiva. RESULTS: Hypotony and choroidal detachment were observed as early postoperative complications during a 1-week period in one-third of the cases in the TE Group, and failing vision in about 45%, while these were seen in fewer cases in the Ex-PRESS Group. No significant difference in intraocular pressure (IOP) was observed during the period, but IOP variations on the day following the surgery were obviously narrower in the Ex-PRESS Group than in the TE Group. Visual acuity was significantly poorer from 1 week to 3 months in the TE Group while it was stable in the Ex-PRESS Group. The Ex-PRESS Group had fewer cases of laser suture lysis and fewer administrations of glaucoma eyedrop, and no cases of progression in the stage of visual field defect. CONCLUSION: Filtration surgery using the Ex-PRESS is unlikely to cause early complications in Japanese patients. Similarly to the trabeculectomy, the intermediate-term control of IOP showed favorable results.

Publication Thread

De Jong 2009

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Primary study

Unclassified

A comparison of the Ex-PRESS™ mini glaucoma shunt with standard trabeculectomy in the surgical treatment of glaucoma.

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Authors Marzette L , Herndon LW
Journal Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye
Year 2011
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This article is included in 3 Systematic reviews Systematic reviews (3 references)

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BACKGROUND AND OBJECTIVE: To compare the success and complication rates of patients with glaucoma who had an Ex-PRESS mini glaucoma shunt device implantation (Optonol, Ltd., Neve Ilan, Israel) to those who had conventional trabeculectomy. PATIENTS AND METHODS: The records of 76 eyes of 69 consecutive subjects who had Ex-PRESS implants and 77 eyes of 65 consecutive controls who had trabeculectomy procedures were reviewed. All surgeries were performed by one of the authors (LWH). Success was defined as an intraocular pressure (IOP) between 5 and 21 mm Hg in patients who did not require further glaucoma surgery in the eye of note. RESULTS: The difference in the percentage of cases of postoperative hypotony between the standard trabeculectomy group (16%) and the Ex-PRESS group (4%) was statistically significant (P = .023). CONCLUSION: The Ex-PRESS device is at least as effective as the standard trabeculectomy in lowering the IOP of patients with glaucoma, with a significantly lower risk of postoperative hypotony. The data further suggest that the Ex-PRESS device results in an overall greater percentage reduction in IOP than with trabeculectomy, although this did not reach statistical significance.

Primary study

Unclassified

Assessment of bleb morphologic features and postoperative outcomes after Ex-PRESS drainage device implantation versus trabeculectomy

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Authors Good TJ , Kahook MY
Journal Am J Ophthalmol
Year 2011

This article is included in 3 Systematic reviews Systematic reviews (3 references)

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Primary study

Unclassified

[Postoperative outcomes after combined glaucoma surgery. Comparison of ex-press miniature implant with standard trabeculectomy].

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Journal Archivos de la Sociedad Espanola de Oftalmologia
Year 2009
Links Pubmed

This article is included in 3 Systematic reviews Systematic reviews (3 references)

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PURPOSE: To evaluate postoperative outcomes and success after combined phacoemulsification and glaucoma surgery with Ex-PRESS miniature implant compared with combined surgery with standard trabeculectomy. METHODS: In this prospective series of 40 consecutive eyes we compared 20 eyes in 17 patients treated with combined phacoemulsification and glaucoma filtering surgery with the Ex-PRESS miniature glaucoma implant under a scleral flap with 20 matched control eyes in 20 patients who underwent combined cataract and glaucoma surgery with trabeculectomy. RESULTS: The average follow-up was 9.7 months (range 4.5 to 15) for the Ex-PRESS group and 10.3 months (range 3.5 to 14.5) for the trabeculectomy group. The mean IOP was significantly higher in the early postoperative period in the Ex-PRESS group compared with the trabeculectomy group. Complications rate in the early postoperative period was significantly higher in the trabeculectomy group. No significant differences were objectified in success between both groups after the first week. DISCUSSION: The Ex-PRESS implant is an effective and safe alternative to standard trabeculectomy in selected cases which makes possible to reduce remarkably the classic early postoperative complications associated with trabeculectomy.

Primary study

Unclassified

Comparison of trabeculectomy with Ex-PRESS miniature glaucoma device implanted under scleral flap.

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Authors Maris PJ , Ishida K , Netland PA
Journal Journal of glaucoma
Year 2007
Links Pubmed DOI

This article is included in 4 Systematic reviews Systematic reviews (4 references)

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PURPOSE: To evaluate the Ex-PRESS miniature implant (Model R 50) placed under partial-thickness scleral flap compared with standard trabeculectomy. METHODS: In this retrospective comparative series of 100 eyes, we compared 50 eyes in 49 patients treated with the Ex-PRESS miniature glaucoma implant under a scleral flap with 50 matched control eyes in 47 patients treated with trabeculectomy. Success was defined as intraocular pressure (IOP) > or =5 mm Hg and < or =21 mm Hg, with or without glaucoma medications, without further glaucoma surgery or removal of implant. Early postoperative hypotony was defined as IOP <5 mm Hg during the first postoperative week. RESULTS: The average follow-up was 10.8 months (range 3.5 to 18) for the Ex-PRESS group and 11.2 months (range 3 to 15) for the trabeculectomy group. Although the mean IOP was significantly higher in the early postoperative period in the Ex-PRESS group compared with the trabeculectomy group, the reduction of IOP was similar in both groups after 3 months. The number of postoperative glaucoma medications in both groups was not significantly different. Kaplan-Meier survival curve analysis showed no significant difference in success between the 2 groups (P=0.594). Early postoperative hypotony and choroidal effusion were significantly more frequent after trabeculectomy compared with Ex-PRESS implant under scleral flap (P<0.001). CONCLUSIONS: The Ex-PRESS implant under a scleral flap had similar IOP-lowering efficacy with a lower rate of early hypotony compared with trabeculectomy.