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A. R. Anchala, T. Obertynski, J. Yonker, B. Hughes; A Comparative Study of Trabeculectomy versus Ex-PRESS Shunt in the Treatment of Uncontrolled Glaucoma in a Detroit Urban Population. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4177.
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To compare the difference in outcome between trabeculectomy versus R-50 Ex-PRESS shunt implantation under a partial thickness scleral flap for medically uncontrolled glaucoma in an urban population.
Retrospective chart review was conducted on patients who underwent either trabeculectomy or Ex-PRESS implantation by one surgeon. Inclusion criteria were primary or secondary Ex-PRESS implantation (Group 1) or primary trabeculectomy (Group 2). Intraocular pressure (IOP) and number of medications (NOM) were recorded preoperatively and at each subsequent follow-up visit. Paired and unpaired t-tests were used to compare IOP and NOM. Significance was assumed to be p<0.05. Hypotony was defined as an IOP of <5 mm Hg.
Forty nine patients met inclusion criteria for Group 1 and 32 met criteria for Group 2. Mean IOP decreased from 29.6 mmHg to 14.3 mmHg in Group 1 (p=0.0001) Mean IOP decreased from 32.8 mmHg to 15.8 mmHg in group 2 (p=0.0001). Mean decrease in medications in group 1 was 2.7 to 1.1 (p=0.0001). Mean decrease in medications in the trabeculectomy group was 2.9 to 0.7 (p=0.0001). There was no statistically significant difference between Groups 1 and 2 in reduction of IOP (p=0.69) or NOM (p=0.24). Patients were also stratified into primary Ex-PRESS (Group 3) versus primary trabeculectomy (Group 2). Mean IOP decreased from 30.2 mmHg to 14.8 mmHg in Group 3(p=0.0001). Mean decrease in medications in Group 3 was 2.7 to 0.9 (p=0.0002). There was no statistically significant difference between Groups 2 and 3 in reduction of IOP (p=0.71) or NOM (p=0.50). Group 1 had four cases of postoperative hypotony; Group 2 had no such cases.
Ex-PRESS shunt implantation has a similar outcome in terms of IOP control and reduction in medication as compared to trabeculectomy in an urban setting. There was less postoperative hypotony in the Ex-PRESS shunt group.
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