Clinical Ophthalmology (Aug 2023)

Ex-PRESS Implantation versus Trabeculectomy for Long-Term Maintenance in Patients with Open-Angle Glaucoma

  • Tokumo K,
  • Okada N,
  • Onoe H,
  • Komatsu K,
  • Masuda S,
  • Okumichi H,
  • Hirooka K,
  • Asaoka R,
  • Kiuchi Y

Journal volume & issue
Vol. Volume 17
pp. 2525 – 2537

Abstract

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Kana Tokumo,1 Naoki Okada,1 Hiromitsu Onoe,1 Kaori Komatsu,1 Shun Masuda,1 Hideaki Okumichi,1 Kazuyuki Hirooka,1 Ryo Asaoka,2 Yoshiaki Kiuchi1 1Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan; 2Seirei Hamamatsu General Hospital Department of Ophthalmology, Shizuoka, JapanCorrespondence: Kana Tokumo, Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan, Tel +81-822575247, Fax +81-822575249, Email [email protected]: To compare the efficacy of Ex-PRESS implantation (EXP) with that of trabeculectomy (TLE) with mitomycin C for maintaining low target intraocular pressure (IOP) in patients with open-angle glaucoma.Patients and Methods: Patients were randomly assigned to receive EXP or TLE. Surgical success was defined according to three target mean IOP ranges (5 mmHg ≤ IOP ≤ 18 mmHg [criterion A], 5 mmHg ≤ IOP ≤ 15 mmHg [criterion B], and 5 mmHg ≤ IOP ≤ 12 mmHg [criterion C]) representing reductions of at least 20% below the baseline on two consecutive follow-up visits 3 months post-surgery, with or without antiglaucoma medication and without further glaucoma surgery. Participants were divided into three subgroups based on baseline mean deviation (MD) values: early (MD ≥ − 6 dB), moderate (− 6 dB > MD ≥ − 12 dB), and advanced (− 12 dB > MD). Survival rates were calculated by subgroup.Results: A total of 73 patients, including 30 in the EXP group and 43 in the TLE group, were included in the study. No significant differences in baseline ocular or demographic characteristics were found between the two groups. No significant difference in IOP was noted every 6 months. After the 3-year follow-up, success rates were A) 60.0% and 60.2%, B) 45.7% and 58.1%, and C) 31.5% and 40.5% for the EXP and TLE groups, respectively. Moreover, there was no difference in success rate based on glaucoma level. Many glaucoma medications administered before surgery were associated with a higher failure rate in the TLE group but not in the EXP group.Conclusion: Both procedures resulted in similar IOP reductions and success rates for a low target IOP. The number of preoperative glaucoma medications was a risk factor for TLE failure.Keywords: filtration surgery, glaucoma, randomized controlled clinical trial, visual field

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