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J. S. Hoop, P. L. Tsai, L. B. Cantor, L. S. Morgan; Early Post Operative Complications and Results in Ex-PRESSTM Shunt versus Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):451.
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To examine early post-operative surgical outcomes in patients undergoing Ex-PRESSTM shunt versus trabeculectomy (trab) with mitomycin-C
A randomized prospective study of patients treated between January 1, 2008 and September 1, 2008 with either Ex-PRESSTM shunt or trab for uncontrolled glaucoma. Fifteen patients (8 Ex-PRESSTM, 7 trab) were examined post-operatively at 1 day, 1 week, 2 week, 1 month, and 2 month visits with additional visits as deemed necessary. Early (within 2 months) post-operative outcomes were examined, including intraocular pressure (IOP), visual acuity (LogMAR VA), and post-operative complications.
IOP dropped significantly in both Ex-PRESSTM (p=0.003) and trab patients (p=0.0001). Mean IOP decreased after Ex-PRESSTM (-11.9 mm Hg) and trab (-17.7 mm Hg). Mean percentage of IOP decrease was -51.5% for Ex-PRESSTM and -74.7% for trab patients (p=0.038). LogMAR VA worsened in patients undergoing Ex-PRESSTM (0.25) and trab (0.11), (p=0.171). The incidence of bleb leak, hyphema, and persistent iritis were the same in both groups. Choroidal detachments were noted in 2 Ex-PRESSTM patients and 3 trab patients, despite the difference in IOP between the two groups. Three Ex-PRESSTM patients, and 7 trab patients experienced hypotony (IOP<5) during the first 2 months.
All patients had post-operative IOP lowering with discontinuation of all topical glaucoma medicines. Trab patients had greater IOP reduction and a significantly greater mean percentage IOP decrease than Ex-PRESSTM patients. Both groups experienced visual acuity decline within the early post-operative period. There was no difference in early post-operative complications of bleb leak, hyphema, or persistent iritis between the two groups. Choroidal detachments were detected in similar frequency in both subsets. Trab patients had a 2.5 times higher incidence of hypotony during the early post-operative period, but that difference resolved by 2 months. The Ex-PRESSTM shunt demonstrates significant early IOP control without increased post-operative complications, and appears to be a reasonable alternative to trabeculectomy.
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