Comparison of Subconjunctival Mitomycin C Augmented Trabeculectomy With and Without Ex-PRESSTM Mini Glaucoma Shunt

Abstract

Purpose: : Compare efficacy of trabeculectomy with subconjunctival injection of Mitomycin C with and without using the Ex-PRESS^TM Mini Glaucoma Shunt for the treatment of refractory glaucoma.

Methods: : Retrospective study including subjects ≥ 18 years of age with failed medical management of glaucoma having received either Trabeculectomy or Phacotrabeculectomy with or without the EX-PRESS^TM Mini Shunt implant.Charts were reviewed to identify subjects who had glaucoma surgery and post-surgical care at Brooke Army Medical Center between Sept. 2007 and Dec. 2008 by one surgeon. Records from Sept. 2007 to Jun. 2009 were reviewed. Subjects included had a minimum of 6 months of follow-up. Preop data included: age, gender, race, glaucoma diagnosis, number of glaucoma medications, Va, glaucoma treatments and IOP. Post-op management information included: IOP, number of glaucoma medications, Va, complications, and required revisions. Postop intervals included: post-op day 1, week 1, and months 1, 3, 6, 9, and 12.Post Surgical Management Criteria for success are defined as:-Superb Outcome: IOP ≥5mm Hg and ≤ 16 mm Hg without glaucoma medications and without total loss of vision-Good Outcome: IOP >16mm Hg and ≤ 18 mm Hg without glaucoma medications and without total loss of vision-Acceptable Outcome: IOP ≥5mm Hg and ≤ 18 mm Hg with glaucoma medications and without total loss of vision-Overall Successful Outcome: IOP ≥5mm Hg and ≤ 18 mm Hg with or without glaucoma medications and without total loss of vision-Failed Outcome: IOP > 18 mm Hg and or further glaucoma surgery or total loss of vision

Results: : Study included 46 subjects in equal groups. Averaging IOP over a 12 month period, 61% of patients without the shunt and 35% of patients with the shunt had a superb outcome. This was not statistically significant (p=0.082). Postop day 1, 26% of subjects with the shunt and 4% of patient without the shunt had a complication. This was statistically significant (p=0.04). Postop day 1, 4% without the shunt and 8% with the shunt had hyptony. This was not statistically significant (p=.550). Postop week 1, both groups had 8.9% hyptony (p=1.0). 22% of patients without the shunt required revisions and 39% of patients with the shunt required revisions; however, this was not statistically significant (p=0.2). Failure rate was 30% for patients without the shunt and 26% for patients with the shunt. This difference was not statistically significant (p=0.73).

Conclusions: : Overall, there was no significant difference for trabeculectomy with and without the Ex-PRESS Glaucoma Shunt in efficacy, complication rates, required revisions, and failure.

Keywords: intraocular pressure