ExPRESS shunt surgery: preferred glaucoma surgery in residency training?

Area of Science:

• Ophthalmic surgery
• Glaucoma treatment
• Surgical training

Background:

• Equipping future ophthalmic surgeons requires effective training methods that prioritize patient safety.
• Trabeculectomy is a standard glaucoma surgery, but can be associated with complications.
• ExPRESS implant surgery shares similarities with trabeculectomy but may offer advantages.

Purpose of the Study:

• To evaluate the ExPRESS implant as a training tool for novice ophthalmic surgeons.
• To compare the ExPRESS implant surgery with trabeculectomy regarding efficacy, technique, and patient outcomes.
• To assess the advantages and disadvantages of ExPRESS implantation for surgical training.

Main Methods:

• Comparison of ExPRESS implant surgery and trabeculectomy in terms of surgical technique and efficacy.
• Analysis of postoperative outcomes, including trauma, hypotony, and medication requirements.
• Evaluation of the challenges associated with ExPRESS implantation and subsequent procedures like needling.

Main Results:

• ExPRESS implant surgery is comparable to trabeculectomy in efficacy and technique.
• ExPRESS surgery is less traumatic, with potentially less postoperative hypotony and reduced need for hypotensive medications.
• ExPRESS implantation is more expensive, involves a foreign body, and subsequent needling is more challenging.

Conclusions:

• ExPRESS implant surgery provides a viable, less risky method for training novice surgeons in glaucoma surgery techniques.
• While beneficial for training, the higher cost and technical difficulties of ExPRESS revision procedures are important considerations.
• The ExPRESS implant offers a valuable alternative for surgical education, balancing skill acquisition with patient safety.