Ex-PRESS Implantation versus Trabeculectomy for Long-Term Maintenance in Patients with Open-Angle Glaucoma

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Surgical Outcomes

Background:

• Open-angle glaucoma requires effective surgical interventions to manage intraocular pressure (IOP).
• Trabeculectomy with mitomycin C (TLE) is a common glaucoma surgery.
• Ex-PRESS implantation (EXP) offers an alternative surgical approach.

Purpose of the Study:

• To compare the efficacy of Ex-PRESS implantation (EXP) versus trabeculectomy (TLE) with mitomycin C.
• To evaluate the maintenance of low target intraocular pressure (IOP) in open-angle glaucoma patients.

Main Methods:

• Randomized comparison of EXP and TLE in 73 open-angle glaucoma patients.
• Surgical success defined by three target IOP ranges (≤18, ≤15, ≤12 mmHg) at 3 months post-surgery.
• Analysis of success rates across early, moderate, and advanced glaucoma severity subgroups.

Main Results:

• No significant difference in IOP reduction between EXP and TLE groups over 3 years.
• Success rates at 3 years were comparable: A) 60.0% (EXP) vs. 60.2% (TLE), B) 45.7% vs. 58.1%, C) 31.5% vs. 40.5%.
• Higher preoperative glaucoma medication use correlated with TLE failure, but not EXP failure.

Conclusions:

• Both EXP and TLE achieve similar low target IOP and success rates in open-angle glaucoma.
• Preoperative medication burden is a significant risk factor for TLE failure.
• EXP may offer an advantage for patients with higher medication needs.