Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2014 Jan 23;9(1):e86045.
doi: 10.1371/journal.pone.0086045. eCollection 2014.

Ex-PRESS implantation versus trabeculectomy in open-angle glaucoma: a meta-analysis of randomized controlled clinical trials

Guohai Chen  1 , Wensheng Li  2 , Fangzheng Jiang  1 , Sihong Mao  1 , Yuhua Tong  1
Affiliations
Meta-Analysis

Ex-PRESS implantation versus trabeculectomy in open-angle glaucoma: a meta-analysis of randomized controlled clinical trials

Guohai Chen et al. PLoS One. .

Abstract

Objective: To evaluate the efficacy and safety of Ex-PRESS implantation (Ex-PRESS) compared to trabeculectomy in the treatment of patients with open-angle glaucoma (OAG).

Methods: A comprehensive literature search using the Cochrane Methodology Register to identify randomized controlled clinical trials (RCCTs) comparing Ex-PRESS to trabeculectomy in patients with OAG. Efficacy estimates were measured by weighted mean difference (WMD) for the percentage intraocular pressure reduction (IOPR%) from baseline to end-point, and odds ratios (OR) for the complete success rate and postoperative interventions. Safety estimates were measured by OR for postoperative complications. Statistical analysis was performed using the RevMan 5.1 software.

Results: A total of four RCCTs were selected for this meta-analysis, including 215 eyes of 200 patients (110 eyes in the Ex-PRESS group, 105 eyes in the trabeculectomy group). There was no significant difference between Ex-PRESS and trabeculectomy in the IOPR% (WMD = 3.15; 95% confidence interval (CI), -6.17-12.47; P = 0.51). The pooled OR comparing Ex-PRESS to trabeculectomy for the complete success rate at one year after surgery were in favor of Ex-PRESS (OR = 2.93; 95% CI, 1.39-6.16; P = 0.005). The Ex-PRESS procedure was found to be associated with lower number of postoperative interventions (OR = 0.23; 95% CI, 0.07-0.81; P = 0.02) and with a significantly lower frequency of hyphema than trabeculectomy (OR = 0.21; 95% CI, 0.05-0.85; P = 0.03), whereas other complications did not differ statistically.

Conclusion: In OAG, Ex-PRESS and trabeculectomy provided similar IOP control, but Ex-PRESS was more likely to achieve complete success, with fewer postoperative interventions. Complication rates were similar for the two types of surgery, except for a lower frequency of hyphema in the Ex-PRESS group.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow diagram of studies included in this meta-analysis. RCCT = randomized controlled clinical trial.
Figure 2
Figure 2. Percent intraocular pressure reduction from baseline comparing Ex-PRESS to trabeculectomy.
SD = standard deviation; IV = inverse variance; CI = confidence interval; Ex-PRESS = Ex-PRESS implantation.
Figure 3
Figure 3. Complete success at one year after surgery comparing Ex-PRESS to trabeculectomy.
M-H = Mantel-Haenszel; CI = confidence interval; Ex-PRESS = Ex-PRESS implantation.
Figure 4
Figure 4. Postoperative interventions comparing Ex-PRESS to trabeculectomy.
M-H = Mantel-Haenszel; CI = confidence interval; Ex-PRESS = Ex-PRESS implantation.
Figure 5
Figure 5. Postoperative complications comparing Ex-PRESS to trabeculectomy.
M-H = Mantel-Haenszel; CI = confidence interval; Ex-PRESS = Ex-PRESS implantation.
See this image and copyright information in PMC

References

    1. Quigley HA, Broman AT (2006) The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol 90: 262–267. - PMC - PubMed
    1. Borisuth NS, Phillips B, Krupin T (1999) The risk profile of glaucoma filtration surgery. Curr Opin Ophthalmol 10: 112–116. - PubMed
    1. Gedde SJ, Herndon LW, Brandt JD, Budenz DL, Feuer WJ, et al. (2007) Surgical complications in the Tube Versus Trabeculectomy Study during the first year of follow-up. Am J Ophthalmol 143: 23–31. - PubMed
    1. Stewart RM, Diamond JG, Ashmore ED, Ayyala RS (2005) Complications following Ex-PRESS glaucoma shunt implantation. Am J Ophthalmol 140: 340–341. - PubMed
    1. Tavolato M, Babighian S, Galan A (2006) Spontaneous extrusion of a stainless steel glaucoma drainage implant (Ex-PRESS). Eur J Ophthalmol 16: 753–755. - PubMed

MeSH terms

LinkOut - more resources