Skip to main content

Advertisement

SpringerLink
Log in

Comparison of the 1-year postoperative results of phacoemulsification–trabeculectomy and phacoemulsification–ExPRESS miniature shunt combined surgeries

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Background and objective

This study aimed to compare the 1-year postoperative phacoemulsification–trabeculectomy (P-Trab) and phacoemulsification–ExPRESS® (P-200 model) miniature shunt (P-ExPRESS) combined surgeries.

Materials and methods

This retrospective, comparative clinical study investigated 41 eyes of 41 patients diagnosed with open-angle glaucoma and cataract. Of these, 21 eyes underwent P-Trab surgery and 20 eyes underwent P-ExPRESS surgery. The 1-year follow-up results, including intraocular pressure (IOP), visual acuity (VA), medications, and complications, were reviewed and compared. A 5 ≤ IOP ≤ 18 mmHg or 30% reduction from baseline was defined as Qualified Success (QS-1), and target IOP without medication was defined as Complete Success (CS-1). A 5 ≤ IOP ≤ 15 mmHg or 40% reduction from baseline was defined as Qualified Success (QS-2), and target IOP without medication was defined as Complete Success (CS-2).

Results

The mean follow-up time was 16 months (12–26 months). Results after the twelfth month for P-Trab versus P-ExPRESS are: CS-1: 42.8% versus 60.0% (P = 0.354); QS-1: 86.7% versus 95% (P = 0.606); CS-2:33.3% versus 40% (P = 0.751); QS-2: 66.6% versus 75% (P = 0.733). Kaplan–Meier survival analysis was not statistically significant between two groups for both QS-1, CS-1 and QS-2, CS-2 (P = 0.329 vs P = 0.365, P = 0.765 vs P = 0.789, respectively). Pre-op mean IOP was: 33.19 ± 8.7 versus 34.55 ± 11.3 mmHg; post-op mean IOP was: 15.19 ± 3.07 versus 15.30 ± 3.32 mmHg (P = 0.913); pre-op mean VA was: 1.17 ± 1.04 versus 1.15 ± 1.07 logMAR; and post-op mean VA was: 0.61 ± 0.80 versus 0.66 ± 0.99 logMAR (P = 0.869). The pre-op mean number of antiglaucomatous medications was 3.76 ± 0.53 versus 3.30 ± 1.45, and the post-op results were 1.52 ± 1.53 versus 0.85 ± 1.26 (P = 0.135). Comparing the pre-op and post-op values, both types of surgeries were equally effective (P = 0.00). Surgical failure was 14.2% (3/21) versus 5% (1/20), and the incidence ratios of significant complications were: 47% (10/21) versus 10% (2/20) and P-Trab versus P-ExPRESS, respectively (P = 0.015).

Conclusion

The 1-year postoperative results suggest that P-ExPRESS is as effective as P-Trab, with fewer complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. European Glaucoma Society (2014) Terminology and guidelines for glaucoma, chapter 2, 4th edn. European Glaucoma Society, Brussels, p 79

    Google Scholar 

  2. De Jong L, Lafuma A, Aguadé A-S et al (2011) Five-year extension of a clinical trial comparing the EX-PRESS glaucoma filtration device and trabeculectomy in primary open-angle glaucoma. Clin Ophthalmol 5:527–533

    PubMed  PubMed Central  Google Scholar 

  3. Gedde SJ, Schiffman JC, Feuer WJ et al (2012) Treatment outcomes in the tube versus trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol 153:789–803

    Article  Google Scholar 

  4. Mendoza-Mendieta ME, López-Venegas AP, Valdés-Casas G (2016) Comparison between the EX-PRESS P-50 implant and trabeculectomy in patients with open-angle glaucoma. Clin Ophthalmol 10:269–276

    Article  CAS  Google Scholar 

  5. Cairns JE (1968) Trabeculectomy. Preliminary report of a new method. Am J Ophthalmol 66(4):673–679

    Article  CAS  Google Scholar 

  6. Netland PA, Sarkisian SR, Moster MR et al (2014) Randomized, prospective, comparative trial of EX-PRESS glaucoma filtration device versus trabeculectomy (XVT study). Am J Ophthalmol 157:433–440

    Article  Google Scholar 

  7. Good TJ, Kahook MY (2011) Assessment of bleb morphologic features and postoperative outcomes after Ex-PRESS drainage device implantation versus trabeculectomy. Am J Ophthalmol 151:507–513

    Article  Google Scholar 

  8. Wang W, Zhou M, Huang W et al (2013) Ex-PRESS implantation versus trabeculectomy in uncontrolled glaucoma: a meta-analysis. PLoS ONE 8(5):e63591. https://doi.org/10.1371/journal.pone.0063591

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Dahan E, Carmichael TR (2005) Implantation of a miniature glaucoma device under a scleral flap. J Glaucoma 14(2):98–102

    Article  Google Scholar 

  10. Shaarawy T, Grahn F, Sherwood M (2009) WGA guidelines on design and reporting glaucoma surgical trials. Kugler Book, Amsterdam

    Google Scholar 

  11. Weinreb RN, Garway-Heath DF, Leung C, Medeiros FA, Liebmann J (2016) World Glaucoma Association, diaognosis of primary open angle glaucoma, consensus series-10. Kugler Publications, Amsterdam

    Google Scholar 

  12. Wang W, Zhou MW, Huang WB et al (2017) Ex-PRESS implantation versus trabeculectomy in Chinese patients with POAG: fellow eye pilot study. Int J Ophthalmol 10(1):56–60

    PubMed  PubMed Central  Google Scholar 

  13. Gedde SJ, Singh K, Schiffman JC, The Tube Versus Trabeculectomy Study Group et al (2012) The tube versus trabeculectomy study: interpretation of results and application to clinical practice. Curr Opin Ophthalmol 23:118–126. https://doi.org/10.1097/icu.0b013e32834ff2d1

    Article  PubMed  Google Scholar 

  14. Wagschal LD, Trope GE, Jinapriya D et al (2015) Prospective randomized study comparing Ex-PRESS to trabeculectomy: 1-year results. J Glaucoma 24:624–629

    Article  Google Scholar 

  15. Konopinska J, Deniziak M, Saeed E et al (2015) Prospective randomized study comparing combined phaco-ExPress and phacotrabeculectomy in open angle glaucoma treatment: 12-month follow-up. J Ophthalmol 720:109. https://doi.org/10.1155/2015/720109

    Article  Google Scholar 

  16. Gallego-Pınazo R, Lopez-Sanchez E, Marin-Montiel J (2009) Postoperative outcomes after combined glaucoma surgery. Comparison of Ex-press miniature implant with standard trabeculectomy. Arch Soc Esp Oftalmol 84:293–298

    PubMed  Google Scholar 

  17. Dahan E, Ben Simon GJ, Lafuma A (2012) Comparison of trabeculectomy and Ex-PRESS implantation in fellow eyes of the same patient: a prospective, randomised study. Eye 26:703–710. https://doi.org/10.1038/eye.2012.13

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Gonzalez-Rodriguez JM, Trope GE, Drori-Wagschal L et al (2016) Comparison of trabeculectomy versus Ex-PRESS: 3-year follow-up. Br J Ophthalmol 100:1269–1273. https://doi.org/10.1136/bjophthalmol-2015-307161

    Article  PubMed  Google Scholar 

  19. Liu J-H, Lin HY, Tzeng S-H et al (2015) Comparison of trabeculectomy with Ex-PRESS shunt implantation in primary-open-angle glaucoma patients: a retrospective study. Taiwan J Ophthalmol 5(3):120–123. https://doi.org/10.1016/j.tjo.2015.04.004

    Article  PubMed  PubMed Central  Google Scholar 

  20. Tojo N, Otsuka M, Hayashi A (2018) Conventional trabeculectomy versus trabeculectomy with the Ex-PRESS® mini-glaucoma shunt: differences in postoperative interventions. Clin Ophthalmol 12:643–650

    Article  Google Scholar 

  21. Patel HY, Drori Wagschal L, Trope GE et al (2014) Economic analysis of the Ex-PRESS miniature glaucoma device versus trabeculectomy. J Glaucoma 23:385–390

    Article  Google Scholar 

  22. Shaarawy T, Goldberg I, Fechtner R (2015) EX-PRESS glaucoma filtration device: review of clinical experience and comparison with trabeculectomy. Surv Ophthalmol 60:327–345

    Article  Google Scholar 

  23. Bustros YD, Fechtner R, Khouri AS (2017) Outcomes of Ex-PRESS and trabeculectomy in a glaucoma population of African origin: one year results. J Curr Glaucoma Pract 11(2):42–47

    Article  Google Scholar 

  24. Arimura S, Takihara Y, Miyake S (2016) Randomized clinical trial for early postoperative complications of Ex-PRESS implantation versus trabeculectomy: complications postoperatively of Ex-PRESS versus trabeculectomy study (CPETS). Sci Rep 6:26080. https://doi.org/10.1038/srep26080

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Hayashi K, Hayashi H, Nakao F et al (2001) Effect of cataract surgery on intraocular pressure control in glaucoma patients. J Cataract Refract Surg 27(11):1779–1786. https://doi.org/10.1016/s0886-3350(01)01036-7

    Article  CAS  PubMed  Google Scholar 

  26. Meyer MA, Savitt ML, Kopitas E (1997) The effect of phacoemulsification on aqueous outflow facility. Ophthalmology 104(8):1221–1227. https://doi.org/10.1016/s0161-6420(97)30154-7

    Article  CAS  PubMed  Google Scholar 

  27. Shingleton BJ, Wadhwani RA, O’Donoghue MW et al (2001) Evaluation of intraocular pressure in the immediate period after phacoemulsification. J Cataract Refract Surg 27(4):524–527. https://doi.org/10.1016/s0886-3350(00)00641-6

    Article  CAS  PubMed  Google Scholar 

  28. Jiang N, Zhao GQ, Lin J et al (2018) Meta-analysis of the efficacy and safety of combined surgery in the management of eyes with coexisting cataract and open angle glaucoma. Int J Ophthalmol 11(2):279–286. https://doi.org/10.18240/ijo.2018.02.17

    Article  PubMed  PubMed Central  Google Scholar 

  29. Noben KJ, Linsen MC, Zeyen TG (1998) Is combined phacoemulsification and trabeculectomy as effective as trabeculectomy alone? Bull Soc Belge Ophtalmol 270:85–90 PMID: 9919785

    CAS  PubMed  Google Scholar 

  30. Stawowski L, Konopinska J, Deniziak M et al (2015) Comparison of ExPress mini-device implantation alone or combined with phacoemulsification for the treatment of open-angle glaucoma. J Ophthalmol 613:280. https://doi.org/10.1155/2015/613280

    Article  Google Scholar 

  31. Seider MI, Rofagha S, Lin SC, Stamper RL (2012) Resident-performed Ex-PRESS shunt implantation versus trabeculectomy. J Glaucoma 21:469–474

    Article  Google Scholar 

  32. Chen G, Li W, Jiang F, Mao S et al (2014) Ex-PRESS implantation versus trabeculectomy in open-angle glaucoma: a meta-analysis of randomized controlled clinical trials. PLoS ONE 9(1):e86045. https://doi.org/10.1371/journal.pone.0086045

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Wang L, Sha F, Guo DD et al (2016) Efficacy and economic analysis of Ex-PRESS implantation versus trabeculectomy in uncontrolled glaucoma: a systematic review and meta-analysis. Int J Ophthalmol 9(1):124–131

    PubMed  PubMed Central  Google Scholar 

  34. Omatsu S, Hirooka K, Nitta E et al (2018) Changes in corneal endothelial cells after trabeculectomy and EX-PRESS shunt: 2-year follow-up. BMC Ophthalmol 18:243. https://doi.org/10.1186/s12886-018-0913-0

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, 34093, Capa, Istanbul, Turkey

    Kemal Turgay Özbilen, Şerife Bayraktar, Emre Altınkurt & Muhammed Talha Sadık

  2. Glaucoma Department, Istanbul Eye Hospital, Bahcelievler, Istanbul, Turkey

    Mehmet Cemil Yılmazlı & Ali Üstüner

Authors
  1. Kemal Turgay Özbilen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Şerife Bayraktar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emre Altınkurt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mehmet Cemil Yılmazlı
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Muhammed Talha Sadık
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ali Üstüner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kemal Turgay Özbilen.

Ethics declarations

Conflict of interest

The authors have no financial or proprietary interest in any materials described in the article. The authors are responsible for the content and writing of the paper. Author Kemal Turgay Özbilen declares that he has no conflict of interest. Author Şerife Bayraktar declares that she has no conflict of interest. Author Emre Altınkurt declares that he has no conflict of interest. Author Mehmet Cemil Yılmazlı declares that he has no conflict of interest. Author Muhammed Talha Sadık declares that he has no conflict of interest. Author Ali Üstüner declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Özbilen, K.T., Bayraktar, Ş., Altınkurt, E. et al. Comparison of the 1-year postoperative results of phacoemulsification–trabeculectomy and phacoemulsification–ExPRESS miniature shunt combined surgeries. Int Ophthalmol 40, 1517–1529 (2020). https://doi.org/10.1007/s10792-020-01321-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-020-01321-8

Keywords

Search

Navigation