Early Postoperative Complications of the Ex-PRESS Implantation versus Trabeculectomy: A Randomized Clinical Trial.

Abstract

Purpose : We aimed to compare early postoperative complications between trabeculectomy and Ex-PRESS implantation.

Methods : Enrolled patients with primary open-angle or exfoliative glaucoma were randomly assigned to receive trabeculectomy (trabeculectomy group) or Ex-PRESS implantation (Ex-PRESS group) (FIGURE 1). Primary outcomes were early postoperative complications, including postoperative anterior chamber inflammation, frequencies of hyphema, flat anterior chamber, choroidal detachment, hypotonic maculopathy, and visual acuity. Secondary outcomes were open anterior chamber duration during surgery, postoperative intraocular pressure, postoperative anti-glaucoma medications, frequencies of laser suture lysis and bleb needling, and the relationship between iris contact with the Ex-PRESS tube and anterior chamber depth in the Ex-PRESS group.

Results : Sixty-four patients were divided between the groups. The Ex-PRESS group had significantly lower flare values between 7 days and 1 month after the surgery (P = 0.015, 0.035, and 0.023 at 7, 10, and 30 days after the surgery, respectively). Hyphema occurred significantly more frequently in the trabeculectomy group (P = 0.0025). The duration of the open anterior chamber was significantly shorter for the Ex-PRESS group (P = 0.0002). The eyes with iris contact with the Ex-PRESS tube had significantly shallower anterior chambers than did the eyes without iris contact (P = 0.013) (FIGURE 2). There were no significant differences between the two groups for other outcomes.

Conclusions : The Ex-PRESS implantation prevented early postoperative inflammation and hyphema in the anterior chamber and shortened the duration of anterior chamber opening. Iris contact with the Ex-PRESS tube occurred more frequently in eyes with open-angle glaucoma and shallow anterior chambers.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.