International Ophthalmology

, Volume 38, Issue 5, pp 1969–1976 | Cite as

Visual acuity and corneal higher-order aberrations after EX-PRESS or trabeculectomy, and the determination of associated factors that influence visual function

  • Nobuko Kobayashi
  • Kazuyuki HirookaEmail author
  • Eri Nitta
  • Kaori Ukegawa
  • Akitaka Tsujikawa
Original Paper



This study investigated postoperative visual acuity and corneal higher-order aberrations following EX-PRESS or trabeculectomy.


Out of 56 eyes of 56 patients analyzed, 30 eyes were treated using trabeculectomy, while 26 eyes were treated with EX-PRESS. Visual acuity and corneal higher-order aberrations were analyzed in both groups before and at 2 weeks, 1, 2, and 3 months after the surgeries. Risk factors that could potentially influence corneal higher-order aberrations were evaluated.


Significant reductions in the IOP were observed at 3 months after the surgery in both groups. Although a significant decrease in the visual acuity (logMAR) was observed at 2 weeks after the surgery in both groups, at 1 month after the surgeries, there were no significant differences found for the vision as compared to the baseline. At each study visit in the trabeculectomy group, significantly higher corneal higher-order aberrations compared to baseline were noted. In the EX-PRESS group, however, these aberrations were no longer significantly different from the baseline at month 2 (P = 0.36). Analysis of the risk factors indicated that hypotony could influence corneal higher-order aberrations after surgery.


Corneal higher-order aberrations were significantly increased at 1 month after EX-PRESS treatment, with levels returning to baseline by 2 months. After trabeculectomy, however, corneal higher-order aberrations remained significantly increased at 3 months after the procedure.


Trabeculectomy EX-PRESS Higher-order aberrations Visual acuity 



This work was supported by a Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (26462689).

Compliance with ethical standards

Conflict of interest

All authors declare that they have 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.


  1. 1.
    Edmunds B, Thompson JR, Salmon JF, Wormald RP (2002) The national survey of trabeculectomy. III. Early and late complications. Eye (Lond) 16:297–303CrossRefGoogle Scholar
  2. 2.
    Francis BA, Hong B, Winarko J, Winarko J, Kawji S, Dustin L, Chopra V (2011) Vision loss and recovery after trabeculectomy: risk and associated risk factors. Arch Ophthalmol 129:1011–1017CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Dahan E, Carmichael TR (2005) Implantation of a miniature glaucoma device under a scleral flap. J Glaucoma 14:98–102CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Maris PJ Jr, Ishida K, Netland PA (2007) Comparison of trabeculectomy with Ex-PRESS miniature glaucoma device implanted under scleral flap. J Glaucoma 16:14–19CrossRefPubMedCentralGoogle Scholar
  5. 5.
    Shaarawy T, Goldberg I, Fechtner R (2015) EX-PRESS glaucoma filtration device: review of clinical experience and comparison with trabeculectomy. Surv Ophthalmol 60:327–345CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Chalita MR, Chavala S, Xu M, Krueger RR (2004) Wavefront analysis in post-LASIK eyes and its correlation with visual symptoms, refraction, and topography. Ophthalmology 111:447–453CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Oshika T, Okamoto C, Samejima T, Tokunaga T, Miyata K (2006) Contrast sensitivity function and ocular higher-order wavefront aberrations in normal human eyes. Ophthalmology 113:1807–1812CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Good TJ, Kahook MY (2011) Assessment of bleb morphologic features and postoperative outcomes after Ex-PRESS drainage device implantation versus trabeculectomy. Am J Ophthalmol 151:507–513CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Beltran-Agullo L, Trope GE, Jin Y, Wagschal LD, Jinapriya D, Buys YM (2015) Comparison of visual recovery following Ex-PRESS versus trabeculectomy: results of a prospective randomized controlled trial. J Glaucoma 24:181–186CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Wagschal LD, Trope GE, Jinapriya D, Jin YP, Buys YM (2015) Prospective randomized study comparing Ex-PRESS to trabeculectomy: 1-year results. J Glaucoma 24:624–629CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Netland PA, Sarkisian SR, Moster MR, Ahmed IK, Condon G, Salim S, Sherwood MB, Siegfried CJ (2014) Randomized, prospective, comparative trial of EX-PRESS glaucoma filtration device versus trabeculectomy. Am J Ophthalmol 157:433–440CrossRefPubMedCentralGoogle Scholar
  12. 12.
    Fukuoka S, Amano S, Honda N, Mimura T, Usui T, Araie M (2011) Effect of trabeculectomy on ocular and corneal higher order aberrations. Jpn J Ophthalmol 55:460–466CrossRefPubMedCentralGoogle Scholar
  13. 13.
    Rosen WJ, Mannis MJ, Brandt JD (1992) The effect of trabeculectomy on corneal topography. Ophthalmic Surg 23:395–398PubMedPubMedCentralGoogle Scholar
  14. 14.
    Dietze PJ, Oram O, Kohnen T, Feldman RM, Koch DD, Gross RL (1997) Visual function following trabeculectomy: effect on corneal topography and contrast sensitivity. J Glaucoma 6:99–103CrossRefPubMedCentralGoogle Scholar
  15. 15.
    Stewart WC, Shields MB (1988) Management of anterior chamber depth after trabeculectomy. Am J Ophthalmol 106:41–44CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Cashwell LF, Martin CA (1999) Axial length decrease accompanying successful glaucoma filtration surgery. Ophthalmology 106:2307–2311CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Francis BA, Wang M, Lei H, Du LT, Minckler DS, Green RL, Roland C (2005) Changes in axial length following trabeculectomy and glaucoma drainage device surgery. Br J Ophthalmol 89:17–20CrossRefPubMedCentralGoogle Scholar
  18. 18.
    de Castro LE, Sandoval HP, Bartholomew LR, Vroman DT, Solomon KD (2007) High-order aberrations and preoperative associated factors. Acta Ophthalmol Scand 85:106–110CrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  • Nobuko Kobayashi
    • 1
  • Kazuyuki Hirooka
    • 1
    Email author
  • Eri Nitta
    • 1
  • Kaori Ukegawa
    • 1
  • Akitaka Tsujikawa
    • 1
  1. 1.Department of OphthalmologyKagawa University Faculty of MedicineMikiJapan

Personalised recommendations