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A. Angelilli, N. Radcliffe, E. Farris; Transitioning From Trabeculectomy to Express Shunt: A Comparative Case Series of Initial Manipulations and Complications. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4185. doi: https://doi.org/.
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To compare the post-operative bleb manipulations required and complications seen within the 90 day global period by a surgeon transitioning from trabeculectomy to the ExPress R-50 shunt for the treatment of glaucoma.
Retrospective review of 19 consecutive cases of trabeculectomy with mitomycin C (MMC) followed by 12 consecutive cases of ExPress R-50 shunt placement under a scleral flap with MMC performed by one experienced glaucoma specialist (EF). Visual acuity, intraocular pressure (IOP), complications, number of bleb manipulations and number of post-operative visits within the 90 day global period were tabulated.
Mean IOP in the trabeculectomy group was reduced from baseline of 25.0 mm Hg ± 8.2 to 10.4 mmHg ± 4.0 at 3 months. Mean IOP in ExPress group was reduced from baseline of 26.2 mmHg ± 6.1 to 12.25 mmHg ± 4.5 at 3 months. Visual acuity decreased by 2 lines or more in 2 (10.5%) and 1 (8.3%) patients in the trabeculectomy (TR) and ExPress (EX) groups, respectively. Complications included shallow choroidal detachments (TR 3 [15.7%], EX 1 [8.3%]), microhyphema (TR 1 [5.2%], EX 0) and intermittent bleb leak (TR 2 [10.5%], EX 1 [8.3%]). Post-operative manipulations included laser suture lysis (TR 12 [63.2%], EX 11 [91.7%]), supplemental injection of MMC (TR 5 [26.3%], EX 4 [33.3%]) and bleb needling with MMC (TR 4 [21.0%], EX 6 [50%]). Seven (36.8%) patients in the trabeculectomy group and 9 (75.0%) patients in the ExPress group required two or more post-operative manipulations. An average of 2.5 visits per month and 2.8 visits per month were required in the trabeculectomy and ExPress groups, respectively.
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