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Ann Mary John, Tamara L Berezina, Robert D Fechtner, Albert S Khouri; Long term outcomes of Ex-PRESS glaucoma filtration surgery in African American patients with glaucoma. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3170.
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To compare intraocular pressure (IOP) reduction, use of glaucoma medications, numbers of post-operative interventions, and success rates in African American patients undergoing Ex-PRESS glaucoma filtration surgery or trabeculectomy for treatment of glaucoma.
A retrospective chart review was performed on 56 African American patients undergoing Ex-PRESS glaucoma shunt (EXP) or trabeculectomy (Trab) between 8/3/2004 and 10/18/2012. All procedures were augmented with Mitomycin C. Data collected included IOP and glaucoma medication use at baseline and post-operative week 1, Month (M) 1, M3, M6, M12, M18, and M24. Post-operative interventions including laser suture lysis (LSL) and 5FU injections were analyzed. Proportion of eyes achieving >30% IOP reduction from baseline, and eyes failing and requiring more surgery were determined. Means, SD, Chi square, and Student T Test were performed.
56 subjects (EXP 28, Trab 28) were included in the analysis. There was a statistically significant reduction (p<0.05) in IOP and number of glaucoma medications at all time points compared to baseline for both groups. Extent of IOP reduction between groups was not statistically significant at any time point, except post-operative week 1 (Table 1). Mean number of glaucoma medications between groups was not significant, except at 3 months and 2 years (lower in EXP group, Table 1). The cumulative number of post-operative interventions within 3 months (LSL and 5FU) was significantly greater for TRAB than EXP (3.89±2.4 vs. 2.36±2.2, p= 0.007). Proportions of eyes achieving>30% IOP reduction from baseline were comparable between both groups (Table 2). Two eyes failed in each the EXP and TRAB groups.
In our cohort of African American patients, the Ex-PRESS shunt was as effective as trabeculectomy in reducing IOP and use of glaucoma medications up to two years. The Ex-PRESS group required fewer post-operative interventions than trabeculectomy patients within 3 months of surgery.
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