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Metasebia T. Munie, Bret A. Hughes, Omar Abbasi, Chaesik Kim; Comparison Of The Efficacy And Safety Of The Ex-Press Shunt With Trabeculectomy In The Surgical Treatment Of Uncontrolled Glaucoma. Invest. Ophthalmol. Vis. Sci. 2011;52(14):636.
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To compare the Ex-Press shunt implanted under a partial scleral flap with standard trabeculectomy in treating uncontrolled glaucoma
In this retrospective study, 81 eyes treated with the Ex-Press shunt under a scleral flap were compared to 132 eyes treated with trabeculectomy. Four criterion for success were defined. Criterion I was defined as IOP of 21mm Hg or less without anti-glaucoma medications or additional glaucoma procedures. Criterion II was the same as Criterion I but 2 or less medications were allowed. Criterion III was defined as IOP reduction of 20% or more of preoperative IOP without anti-glaucoma medications or additional glaucoma procedures. Criterion IV had the same conditions as criterion III but 2 or fewer medications were allowed
The Ex-Press group was followed for an average of 18.80 ± 12.70 months and the trabeculectomy group for 15.68 ± 15.57 months. The change from preoperative IOP was significantly greater at the last follow up in the trabeculectomy group compared to the Ex-Press group, although both showed significant change from baseline values. Success rates at the last follow up were also significantly greater in the trabeculectomy group by criterions III and IV (P=0.0248 and 0.0215 respectively), while there was no difference by criterions I and II. There was no difference between the Kaplan Meier survival curves of the two groups by any of the four criterions. Kaplan Meier curves of eyes with previous glaucoma surgery showed improved survival in the trabeculectomy group by criterions I, III and IV (P = 0.0128, log rank by Criterion I; P = 0.0628, log rank by Criterion II; P = 0.0198, log rank by Criterion III; P = 0.0260, log rank by Criterion IV).Corneal edema was more common after trabeculectomy but the occurrence rate of other complications were comparable
Although we showed the Ex-Press shunt to be a safe and effective option, trabeculectomy was found to be more successful in lowering IOP and was especially more so for patients with previously failed glaucoma surgeries
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