Purchase this article with an account.
Irene Cherfas Tsyvine, Robert D. Fechtner, Amir Cohen, Tamara Berezina, Michelle Pham, Meng Lu; Ex-PRESS Glaucoma Shunt Versus Trabeculectomy: a Retrospective Review of Post-Operative Complications and Need for Intensity of Post-Operative Interventions. Invest. Ophthalmol. Vis. Sci. 2011;52(14):641.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To compare the safety of the Ex-PRESS glaucoma shunt with standard trabeculectomy in the treatment of open angle glaucoma; to compare the frequency and intensity of post-operative interventions
In this retrospective review study,we reviewed 34 eyes of 29 patients in the trabeculectomy group and 23 eyes of 20 patients in the Ex-PRESS group. Main study endpoints were the incidence of complications, and the need for post-operative interventions. Complications were characterized as early (2 weeks), intermediate (two weeks to three months, and late (greater than three months).
Average follow up was 24.9 (3-66) months in the trabeculectomy group, and 19.5 (3-38) months in the Ex-PRESS group. Early hypotony (IOP< or =5 mmHg within 7 days), was found in three eyes in the trabeculectomy group and nine eyes in the Ex-PRESS group( P=0.008). All resolved by post-operative month one. 5-FU injection was performed in 10 eyes for a total of 15 in the Ex-PRESS group, and in 21 eyes for a total of 51 in the trabeculectomy group. Laser suture lysis was done in 11 eyes for a total of 18 in the Ex-PRESS group, and in 26 eyes for a total 53 in the trabeculectomy group (P=0.026). Common early complications were hyphema, choroidal detachment, and bleb leak. Three eyes in the Ex-PRESS group and two eyes in the trabeculectomy group had dchoroidal etachment in the first week (NS). Two eyes in the Ex-PRESS group and one eye in the trabeculectomy group had hyphema at day one (NS). Bleb leaks occurred in one eye in the Ex-PRESS group and two eyes in the trabeculectomy group, and resolved within one week. One eye in the trabeculectomy group had a bleeding conjunctival vessel that was cauterized. In the intermediate period, one eye in the Ex-PRESS group had corneal decompensation, and one eye in the Ex-PRESS group underwent bleb revision. Late complications included blebitis and surgical failure. One eye in the trabeculectomy group developed blebitis at one year. Two eyes in the Ex-PRESS group and one eye in the trabeculectomy group underwent subsequent Baerveldt placement.
In this series, the Ex-PRESS shunt had a higher incidence of early hypotony that resolved by one month. Other complications were infrequent and similar between groups. The standard trabeculectomy required more intensive post-operative interventions, including 5FU injections and laser suture lysis. The incidence of post-operative bleb leaks, hyphema, and choroidal detachment was not found to be statistically significant.
This PDF is available to Subscribers Only