Ex-PRESS Implantation versus Trabeculectomy for Long-Term Maintenance in Patients with Open-Angle Glaucoma
Filtering surgery is widely employed in the treatment of glaucoma with uncontrollable intraocular pressure (IOP). Currently, the most popular filtering surgery is trabeculectomy (TLE), in which aqueous humor filtration is enhanced and the IOP is reduced by creating a scleral flap that leads to bleb formation in the conjunctiva. The success and complication rates for TLE are well established.
The Ex-PRESS glaucoma filtration device (Alcon Laboratories, Fort Worth, TX, USA) was introduced as a modification to TLE. Although its surgical procedure and postoperative management are similar to those of TLE, ExPRESS (EXP) surgery does not require sclerectomy or iridectomy. Therefore, postoperative inflammation and hemorrhage may be reduced. Both surgical procedures can achieve comparable IOP reductions with few complications when the target pressure is set to 18 mmHg. However, the optimal target IOP for glaucoma treatment depends on the disease stage, IOP before treatment, age, and other risk factors. Generally, to maintain visual function, more severe glaucoma requires lower IOP post-surgery.
The success of TLE depends on the preoperative IOP, history of previous surgery, number of preoperative medications, and race. A high incidence of normal-tension glaucoma (NTG) was reported in the Japanese population and visual field impairment in patients with NTG often progresses even when IOP is within the normal range. Therefore, patients with NTG may benefit from a postoperative target pressure below that of patients with higher preoperative IOP. This study compared the efficacy and safety of EXP to TLE to achieve target postoperative IOPs of ≤18, ≤15, and ≤12 mmHg, each representing reductions of at least 20% below the baseline, among Japanese patients with open-angle glaucoma (OAG, including exfoliation glaucoma and primary OAG).
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