July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Comparison of reoperation rates in Ex-PRESS implantation versus trabeculectomy for open-angle glaucoma: national database study in Japan
Author Affiliations & Notes
  • Yohei Hashimoto
    Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Bunkyoku, Tokyo, Japan
  • Nobuaki Michihata
    Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
  • Hiroki Matsui
    Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
  • Kiyohide Fushimi
    Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Bunkyo-ku, Tokyo, Japan
  • Hideo Yasunaga
    Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
  • Makoto Aihara
    Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Bunkyoku, Tokyo, Japan
  • Footnotes
    Commercial Relationships   Yohei Hashimoto, None; Nobuaki Michihata, None; Hiroki Matsui, None; Kiyohide Fushimi, None; Hideo Yasunaga, None; Makoto Aihara, None
  • Footnotes
    Support  the Ministry of Health, Labour and Welfare, Japan (H30-Policy-Designated-004 and H29-ICT-General-004) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141).
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 1958. doi:https://doi.org/
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    • Get Citation

      Yohei Hashimoto, Nobuaki Michihata, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga, Makoto Aihara; Comparison of reoperation rates in Ex-PRESS implantation versus trabeculectomy for open-angle glaucoma: national database study in Japan. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1958. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Ex-PRESS implantation and trabeculectomy have been reported to have similar efficacy in lowering intraocular pressure. However, it remains unknown which is superior in terms of reoperation rate. To compare the reoperation rates for glaucoma between Ex-PRESS implantation and trabeculectomy, we performed a retrospective cohort study using a national inpatient database in Japan.

Methods : Patients aged 18 to 85 years with open-angle glaucoma who underwent Ex-PRESS or trabeculectomy from 2010 to 2017 were included. We compared the reoperation rates for glaucoma between Ex-PRESS and trabeculectomy using mixed-effects Cox regression models. The covariates were sex, age, diabetes mellitus, simultaneous cataract surgery, ocular surgical history, and annual hospital volume for glaucoma surgery. Furthermore, we conducted propensity score (PS) matching and instrumental variable (IV) analyses to confirm the results of the conventional Cox regression. We also compared total hospitalization costs between the two treatments.

Results : In total, 2487 eyes underwent Ex-PRESS and 13,074 eyes underwent trabeculectomy. The reoperation rates were 7.6% and 6.4% in the Ex-PRESS and trabeculectomy groups, respectively. The most frequently performed type of reoperation was trabeculectomy in both groups. The mixed-effects Cox regression showed that Ex-PRESS had significantly higher reoperation rates than trabeculectomy [adjusted hazard ratio (aHR), 1.46; 95% confidence interval (CI), 1.21–1.75; p<0.001]. The PS and IV analyses also showed that Ex-PRESS had significantly higher reoperation rates than trabeculectomy (for PS analysis: aHR, 1.54; 95% CI, 1.23–1.94; p < 0.001; for IV analysis: aHR, 2.51; 95% CI, 1.35–4.68; p=0.004). The average total hospitalization costs of Ex-PRESS ($6901) were significantly greater than that of trabeculectomy ($6066) in the PS matched groups (p < 0.001).

Conclusions : Ex-PRESS implantation had higher reoperation rates for glaucoma and greater cost than trabeculectomy.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

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