A comparative study of combined trabeculectomy with ECCE/PCIOL versus Ex-press Shunt with ECCE /PCIOL

Abstract

Purpose: To compare the success rates of trabeculectomy with ECCE/PCIOL versus Ex-press shunt implantation with ECCE/ PCIOL in glaucoma patients.

Methods: This was a retrospective comparative study that included 204 eyes of 183 patients with the underlying diagnosis of glaucoma. A total of 103 eyes which received trabeculectomy with ECCE/PCIOL and 101 eyes which were implanted with the Ex-press shunt and had ECCE/PCIOL were analyzed. Two criteria were used to determine the rate of surgical success. The stringent Criteria 1 defined success as 4mmHg < intraocular pressure < 19mmHg, use of less than one medication post-operatively, and no further glaucoma surgeries. The lenient Criteria 2 defined success as 4mmHg < intraocular pressure < 21mmHg, use of less than two medications post-operatively, and no further glaucoma surgeries.

Results: The mean follow-up time was 28±18 months for the trabeculectomy with ECCE/PCIOL with a range from 0 to 67 months. The mean follow-up time was 5.6±4.8 months for the Ex-press shunt with ECCE/PCIOL with a range from 0 to 28 months. The surgery success as defined by Criteria 1 had a statistically significant difference, with the mean length of success being 13.53 months for the trabeculectomy and 15.5 months for the Ex-press shunt (p-value of 0.0124). The surgery success as defined by Criteria 2 also had a statistically significant difference, with the mean length of success being 20.56 months for the trabeculectomy and 24.72 months for the Ex-press shunt (p-value of 0.0087).

Conclusions: Both the trabeculectomy and Ex-press shunt are effective procedures for lowering intraocular pressures. However, when using both stringent and lenient criteria for success, the Ex-press shunt with ECCE/PCIOL had a statistically significant higher success rate when compared to the trabeculectomy with ECCE/PCIOL.

Keywords: 465 clinical (human) or epidemiologic studies: systems/equipment/techniques • 743 treatment outcomes of cataract surgery • 629 optic nerve