Trabeculectomy with ExPRESS: weighing the benefits and cost

As glaucoma surgeons continue to search for an improvement over trabeculectomy, the ExPRESS miniature glaucoma shunt has gained interest as a possible contender. Peer-reviewed literature on ExPRESS is beginning to accumulate allowing an evidence-based review to assess the potential benefits and limitations compared to trabeculectomy.

The current surgical procedure for ExPRESS implantation will be described followed by results of studies comparing ExPRESS to trabeculectomy, focusing on the following outcomes: success, intraocular pressure, and complications. Case reports of late complications specific to the ExPRESS device will be summarized. Finally, an economic analysis comparing ExPRESS to trabeculectomy will be provided as additional evidence to contribute to the decision matrix on deciding which filtration procedure to recommend.

Despite a large number of ExPRESS implant procedures worldwide, there is a paucity of high-quality studies comparing ExPRESS to trabeculectomy. From the available literature to date the outcomes (success and early complications) of ExPRESS are similar to trabeculectomy. Reports of late complications related to device extrusion and malposition are beginning to be published; however, the significantly increased cost for ExPRESS surgery is likely to be the main limitation to widespread adoption of this procedure.