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Meta-Analysis
. 2014 Jun 27;9(6):e100578.
doi: 10.1371/journal.pone.0100578. eCollection 2014.

Meta-analysis of randomized controlled trials comparing EX-PRESS implantation with trabeculectomy for open-angle glaucoma

Wei Wang  1 , Xiulan Zhang  1
Affiliations
Meta-Analysis

Meta-analysis of randomized controlled trials comparing EX-PRESS implantation with trabeculectomy for open-angle glaucoma

Wei Wang et al. PLoS One. .

Abstract

Purpose: To evaluate the efficacy and safety of EX-PRESS implantation compared with trabeculectomy for uncontrolled open-angle glaucoma.

Methods: Pertinent randomized controlled trials were identified through systematic searches of the PubMed, EMBASE, and Cochrane Library. The efficacy measures utilized were the weighted mean differences (WMDs) for the intraocular pressure reduction (IOPR), the reduction in glaucoma medications, the change of visual acuity, and the relative risks (RRs) for operative success rates. The safety measures utilized were RRs for postoperative complications. The pooled effects were calculated using the random-effects model.

Results: Four randomized controlled trials of 292 eyes were included in this meta-analysis. The WMDs of the IOPR comparing the EX-PRESS with trabeculectomy were -0.25 (95% Cl: -3.61 to 3.11) at 6 month, 0.053 (-4.31 to 4.42) at 12 months, 0.81 (-4.06 to 5.67) at 24 months, and 0.20 (-2.11 to 2.51) at final follow-up. There was no statistically significance for IOPR at any point after surgery. There were also no significant differences in the reduction in glaucoma medications or visual acuity between the groups. The pooled relative risks comparing EX-PRESS with Trabeculectomy were 1.36 (1.11 to 1.66) for the complete operative success rate and 1.05 (0.94 to 1.17) for the qualified operative success rate. EX-PRESS and Trabeculectomy were associated with similar incidences in most complications with the exception of hyphema, with pooled RR being 0.18 (0.046 to 0.66).

Conclusions: EX-PRESS implantation and trabeculectomy have similar efficacy in IOP-lowering, medication reduction, vision recovery, and qualified operative success rates. EX-PRESS associated with higher rates of complete operative success and fewer hyphema than with Trabeculectomy. However, these should be interpreted with caution because of the inherent limitations of the included studies.

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Conflict of interest statement

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

Figures

Figure 1
Figure 1. Flow of RCTs included in the meta-analysis.
RCTs indicates randomized controlled trials.
Figure 2
Figure 2. Forest plot showing meta-analysis of intraocular pressure reduction in randomized trials comparing EX-PRESS implantation with trabeculectomy.
WMD indicates weighted mean difference, which was computed by using a random effects model.
Figure 3
Figure 3. Forest plot showing meta-analysis of operative success rate in randomized trials comparing EX-PRESS implantation with trabeculectomy.
RR indicates relative risks, which was computed by using a random effects model.
Figure 4
Figure 4. Forest plot showing meta-analysis of glaucoma medication reduction in randomized trials comparing EX-PRESS implantation with trabeculectomy.
WMD indicates weighted mean difference, which was computed by using a random effects model.
Figure 5
Figure 5. Forest plot showing meta-analysis of the change of visual acuity in randomized trials comparing EX-PRESS implantation with trabeculectomy.
WMD indicates weighted mean difference, which was computed by using a random effects model.
See this image and copyright information in PMC

References

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