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M. M. Kaehr, D. WuDunn, Y. M. Catoira-Boyle; Retrospective Comparison of Trabeculectomy With or Without Ex-Press Miniature Shunt as Performed by Resident Surgeons. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4450.
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To compare the outcomes of trabeculectomy with or without Ex-Press Miniature Shunt performed by surgeons in training at an academic institution.
A retrospective analysis was performed comparing patients undergoing glaucoma surgery at the university-affiliated veterans hospital over a three-year period. During the first two years, 51 patients underwent a standard trabeculectomy, and during the third year, 22 patients underwent placement of an Ex-Press Miniature Shunt under a partial thickness scleral flap. The resident surgeon performed all surgeries under the supervision of a single attending surgeon. Postoperative pressures were recorded on day one, weeks one and two, and months one, two, three, and six. Success was defined as 5<=IOP<=21 mm Hg.
There were no statistically significant differences in demographics including age, gender, ethnicity, operative eye, previous surgery or laser, lens status, preoperative IOP or number of glaucoma medications. The only statistically significant difference in post-operative IOP was at week two when the average pressures were 8.9 and 14.5 (p = 0.03, t test) in the trabeculectomy and Ex-Press arms respectively. The average IOP at six months were 9.9 and 12.1 (p=0.21) respectively. The Ex-Press group required more glaucoma medications and more laser suture lysis procedures but the differences were not quite statistically significant (medications at 6 months, 0.68 vs. 1.35, p=0.06 and average number of laser suture lysis procedures 0.57 vs. 0.91, p=0.10). There were no statistically significant differences in complications including choroidal effusions, choroidal folds, bleb leaks, blebitis, flat anterior chamber, hyphema, iridocorneal adhesions, or vitreous loss. Success was achieved in 34/40 (85%) trabeculectomy patients and 13/16 (81%) Ex-Press patients (p=0.73) at six months.
At six months post-operative, there were no statistically significant differences in pressure lowering efficacy, need for medications, complications, need for laser suture lysis, or success between the two groups.
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