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Maheen Haque, Bret Hughes, Justin Tannir, Rominder Momi, Chaesik Kim; Comparison of Early Post-Operative Challenges in P200 Ex-PRESS Shunts and Conventional Trabeculectomies. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4489.
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To evaluate and compare post-operative outcomes for P200 Ex-PRESS shunts and conventional trabeculectomies in achieving intraocular pressure (IOP) control in patients with primary open angle glaucoma (POAG).
This is a retrospective chart review of 30 eyes of 24 patients with POAG who underwent P200 Ex-PRESS shunt placement or conventional trabeculectomy for IOP control by one surgeon (B. Hughes, Detroit, MI). Patients were evaluated prior to surgery and clinical diagnosis was recorded. Best corrected visual acuity (BCVA), IOP, and number of glaucoma medications were followed prior to and following surgery. Postoperative complications were followed for both groups. Patients excluded from analysis included those with a history of neovascular or uveitic glaucoma and those who underwent cataract extraction at or within 6 months of glaucoma surgery.
There were 30 eyes of 24 patients with a mean age of 72 years in the P200 Ex-PRESS group and 64.7 years in the conventional trabeculectomy group. Average length of followup was 13.2 months in the P200 Ex-PRESS group and 25.9 months in the conventional trabeculectomy group (p<0.05). A trend towards better recovery of visual acuity was seen in the P200 Ex-PRESS group but there was not a statistically significant difference in visual acuity between the two groups at any time during the post-operative period. The mean postoperative IOP was found to be lower at all time points for patients in both groups, but was found to be significantly lower in the P200 Ex-PRESS group at 6-9 months (p<0.05). Patients in both groups used less glaucoma medications after surgery but this was not a statistically significant difference. While there were no statistically significant differences in the complications between the two groups, there was a higher incidence of early postoperative hypotony (46.7%, p=.25) and choroidal effusion (26.7%, p=.11) in the P200 Ex-PRESS group. More patients underwent surgical revision in the trabeculectomy group (26.7%, p=.33)
There is a significant decrease in postoperative IOP in both groups. However, there is a statistical trend for lower IOP in patients who undergo surgery with a P200 Ex-PRESS shunt. There is a higher incidence of early postoperative complications in the P200 Ex-PRESS shunt group but more patients require revisional surgery after a conventional trabeculectomy.
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