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. 2015 Aug 18:9:1491-8.
doi: 10.2147/OPTH.S86504. eCollection 2015.

Indications and postoperative treatment for Ex-PRESS(®) insertion in Japanese patients with glaucoma: comparison with standard trabeculectomy

Noriko Kato  1 , Genichiro Takahashi  1 , Koichi Kumegawa  1 , Yoshiaki Kabata  1 , Hiroshi Tsuneoka  2
Affiliations

Indications and postoperative treatment for Ex-PRESS(®) insertion in Japanese patients with glaucoma: comparison with standard trabeculectomy

Noriko Kato et al. Clin Ophthalmol. .

Abstract

Background: We investigated indications and early postoperative treatment for Ex-PRESS(®) insertion for glaucoma by comparing postoperative outcomes with those for standard trabeculectomy.

Methods: Ex-PRESS insertion was performed in 21 eyes and standard trabeculectomy (TLE) in 22 eyes. Mean intraocular pressure (IOP) in the 6 months after surgery, success rate for postoperative IOP decline, postoperative complications, postoperative treatment, filtering blebs, and indications were then retrospectively investigated.

Results: Mean postoperative IOP did not differ significantly between the groups at any observation time for 6 months after surgery. Further, it did not differ between either the groups of patients with primary open-angle glaucoma (POAG) and neovascular glaucoma (NTG), or the patients with primary open-angle glaucoma and NTG in the Ex-PRESS group. Comparison of success rates in reduction of postoperative IOP between the groups under the following four survival conditions showed no significant differences: postoperative IOP <30% of the preoperative IOP, complete success (no additional ophthalmic solution), and qualified success (ophthalmic solution required); 5 mmHg ≤ postoperative IOP ≤21 mmHg, complete success (no additional ophthalmic solution), and qualified success (ophthalmic solution required). With regard to postoperative complications and postoperative treatment, the incidence of hyphema was significantly lower in the Ex-PRESS group, but no other significant intergroup differences were seen. The height of the filtering bleb was lower in the Ex-PRESS group.

Conclusion: Postoperative outcomes in the Ex-PRESS and TLE groups were comparable. The incidence of hyphema was significantly lower in the Ex-PRESS group. Ex-PRESS insertion appears to be useful in patients with NTG and in those prone to postoperative bleeding. There were no significant intergroup differences in postoperative treatment. Assessment of outcome after Ex-PRESS insertion was difficult in some patients. Postoperative treatment should be developed to suit the specific requirements of Ex-PRESS insertion.

Keywords: Ex-PRESS; indications; neovascular glaucoma; postoperative treatment; trabeculectomy.

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Figures

Figure 1
Figure 1
Changes in mean postoperative IOP in all patients. Notes: No significant intergroup differences were seen at any observation point (Mann–Whitney U-test). The 95% confidence interval for the mean IOP at 6 months after surgery was 16.7 (13.2–20.2) mmHg in the Ex-PRESS® group and 14.9 (12.7–17.1) mmHg in the TLE group. Abbreviations: IOP, intraocular pressure; TLE, trabeculectomy.
Figure 2
Figure 2
Changes in mean postoperative IOP for patients with primary open-angle glaucoma. Notes: No significant intergroup differences were seen at any observation point (Mann–Whitney U-test). The 95% confidence interval for the mean IOP at 6 months after surgery was 14.4 (8.6–20.3) mmHg in the Ex-PRESS® group and 11.8 (7.9–15.7) mmHg in the TLE group. Abbreviations: IOP, intraocular pressure; TLE, trabeculectomy.
Figure 3
Figure 3
Changes in mean postoperative IOP for patients with neovascular glaucoma. Notes: No significant intergroup differences were seen at any observation point (Mann–Whitney U-test). The 95% confidence interval of mean IOP at 6 months after surgery was 19.6 (10.0–29.2) mmHg in the Ex-PRESS® group and 18.0 (11.9–24.1) mmHg in the TLE group. Abbreviations: IOP, intraocular pressure; TLE, trabeculectomy.
Figure 4
Figure 4
Changes in mean postoperative IOP in patients with POAG or NVG in the Ex-PRESS® group. Notes: No significant intergroup differences were seen at any observation point (Mann–Whitney U-test). The 95% confidence interval for mean IOP at 6 months after surgery was 14.4 (8.6–20.2) mmHg in the Ex-PRESS® group and 19.6 (10.0–29.2) mmHg in the TLE group. Abbreviations: IOP, intraocular pressure; TLE, trabeculectomy; POAG, primary open-angle glaucoma; NVG, neovascular glaucoma.
Figure 5
Figure 5
Complete success rate after surgery, as measured by the percentage of patients with a postoperative IOP less than 30% of the preoperative IOP. Notes: No significant intergroup differences in success rate were seen at any observation point (log rank test, P=0.84). The success rate at 6 months after surgery was 48.5% in the Ex-PRESS® group and 53.0% in the TLE group. Abbreviations: IOP, intraocular pressure; TLE, trabeculectomy.
Figure 6
Figure 6
Qualified success rate after surgery, as measured by the percentage of patients with a postoperative IOP less than 30% of the preoperative IOP. Notes: No significant intergroup differences in success rate were seen at any observation point (log rank test, P=0.89). The success rate at 6 months after surgery was 70.6% in the Ex-PRESS® group and 71.4% in the TLE group. Abbreviations: IOP, intraocular pressure; TLE, trabeculectomy.
Figure 7
Figure 7
Complete success rate after surgery, as measured by the percentage of patients with a postoperative IOP between 5 and 21 mmHg. Notes: No significant intergroup differences in success rate were seen at any observation point (log rank test, P=0.99). The success rate at 6 months after surgery was 37.1% in the Ex-PRESS® group and 45.5% in the TLE group. Abbreviations: IOP, intraocular pressure; TLE, trabeculectomy.
Figure 8
Figure 8
Qualified success rate after surgery, as measured by the percentage of patients with a postoperative IOP between 5 and 21 mmHg. Notes: No significant intergroup differences in success rate were seen at any observation point (log rank test, P=0.12). The success rate at 6 months after surgery was 46.8% in the Ex-PRESS® group and 71.4% in the TLE group. Abbreviations: IOP, intraocular pressure; TLE, trabeculectomy.
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