Long-term visual field progression after Ex-PRESS implantation versus trabeculectomy in refractory glaucoma

Area of Science:

• Ophthalmology
• Glaucoma Research
• Surgical Outcomes

Background:

• Glaucoma management often involves surgical intervention to control intraocular pressure (IOP).
• Trabeculectomy is a traditional glaucoma surgery, while Ex-PRESS filtration surgery is a newer alternative.
• Long-term functional outcomes, specifically visual field progression, require further comparative analysis.

Purpose of the Study:

• To compare the long-term visual field progression between Ex-PRESS filtration surgery and trabeculectomy.
• To focus on functional visual outcomes rather than solely on intraocular pressure (IOP) control.
• To evaluate outcomes in patients with medically uncontrolled glaucoma.

Main Methods:

• Retrospective analysis of 109 eyes (Ex-PRESS: 51; trabeculectomy: 58) followed for ≥3 years.
• Exclusion of eyes requiring additional glaucoma surgery within 36 months.
• Quantification of visual field progression using the mean deviation (MD) slope (dB/year) via Humphrey or AP-7700 programs, analyzed with a linear mixed-effects model.

Main Results:

• Postoperative IOP was comparable between Ex-PRESS (11.8±2.6 mmHg) and trabeculectomy (11.4±3.0 mmHg) groups.
• Adjusted mean deviation (MD) slopes were -0.20 dB/year for Ex-PRESS and -0.15 dB/year for trabeculectomy (p=0.59).
• Subgroup analyses and correlation with blood pressure did not reveal significant differences in visual field progression.

Conclusions:

• No significant difference in long-term visual field progression was observed between Ex-PRESS implantation and trabeculectomy in eyes without reoperation within 36 months.
• When postoperative IOP is well-controlled, non-IOP vascular factors may contribute to residual visual field progression.
• This study adds to the limited evidence on long-term visual field outcomes following Ex-PRESS implantation.