AIM： To compare the long-term outcomes of the Ex-PRESS miniature glaucoma device implanted under a scleral flap in combination of phacoemulsification with intraocular lens implantation in primary open angle glaucoma ...AIM： To compare the long-term outcomes of the Ex-PRESS miniature glaucoma device implanted under a scleral flap in combination of phacoemulsification with intraocular lens implantation in primary open angle glaucoma （POAG） and chronic primary angle-closure glaucoma （CPACG）.METHODS： Retrospective, comparative study. A total of 60 eyes （60 patients） receiving the Ex-PRESS miniature glaucoma device implantation combined with phacoemulsification were reviewed. Thirty eyes （30 patients） had the combined procedures for POAG, and the other 30 eyes （30 patients） for CPACG. RESULTS： The follow-up was 39.37±7.09mo （range 3 to 49mo） in patients with POAG and 37.10±9.26mo （range 9 to 49mo） in patients with CPACG （P=0.29）. The mean change in best corrected visual acuity was 0.41 logMAR for POAG and 0.38 logMAR for CPACG at the last follow-up （P=0.22）. The postoperative intraocular pressure （IOP） of the POAG group was significantly lower than the CPACG group at 1, 3, 12, and 18mo after surgery （P=0.02, 0.00, 0.04, 0.01） with similar glaucoma medications after surgery （P〉0.16）. At 3y after surgery, the cumulative complete and qualified success rates were 63.3% （POAG） and 53.3% （CPACG）, 83.3% （POAG） and 73.3% （CPACG） （P=0.41, 0.49）, respectively. The POAG group had more hypotony than the CPACG group （P=0.04）.CONCLUSION： The long-term outcomes show the Ex-PRESS implantation combined with phacoemulcification can effectively lower the IOP in both the POAG and CPACG groups. The POAG group seems to have lower postoperative IOP and a higher risk of hypotony.展开更多
AIM：To compare the surgical outcomes of trabeculectomy with Ex-PRESS implant and Ahmed glaucoma valve（AGV） implantation. METHODS： Patients who underwent trabeculectomy with Ex-PRESS implants or AGV implantation se...AIM：To compare the surgical outcomes of trabeculectomy with Ex-PRESS implant and Ahmed glaucoma valve（AGV） implantation. METHODS： Patients who underwent trabeculectomy with Ex-PRESS implants or AGV implantation separately were included in this retrospective chart review.Main outcome measures were surgical failure and complications.Failure was defined as intraocular pressure（IOP） 〉21 mm Hg or 〈5 mm Hg on two consecutive visits after 3mo,reoperation for glaucoma,or loss of light perception.Eyes that had not failed were considered as complete success if they did not required supplemental medical therapy.RESULTS： A total of 64 eyes from 57 patients were included： 31 eyes in the Ex-PRESS group and 33 eyes in the AGV group.The mean follow-up time was 2.6 ±1.1y and 3.3±1.6y,respectively.Patients in the AGV group had significantly higher baseline mean IOP（P =0.005）,lower baseline mean visual acuity（VA）（P =0.02）,and higher proportion of patients with history of previous trabeculectomy（P 〈0.0001）.Crude failure rates were 16.1%,n =5/31 in the Ex-PRESS group and 24.2%,n =8/33 in the AGV group.The cumulative proportion of failure was similar between the groups,P =0.696.The proportion of eyes that experienced postoperative complications was32.3% in the Ex-PRESS group and 60.1% in the AGV group（P =0.0229）.CONCLUSION： Trabeculectomy with Ex-PRESS implant and AGV implantation had comparable failure rates.The AGV group had more post-operative complications,but also included more complex cases with higher baselinemean IOP,worse baseline mean VA,and more previous glaucoma surgeries.Therefore,the results are limited to the cohort included in this study.展开更多
AIM: To evaluate the clinical results, efficacy and safety of Ex-PRESS P200 glaucoma shunt implant in different types of medically uncontrolled glaucoma. METHODS: The study included 31 eyes of 31 patients that were un...AIM: To evaluate the clinical results, efficacy and safety of Ex-PRESS P200 glaucoma shunt implant in different types of medically uncontrolled glaucoma. METHODS: The study included 31 eyes of 31 patients that were unresponsive to medical antiglaucomatous therapy in whom Ex-PRESS P200 glaucoma shunt implantation was performed. The demographic characteristics of the patients, type of glaucoma, complete ocular examination results, number of antiglaucomatous drugs before and after surgery, early and late complications of surgery, additional surgical and nonsurgical medical interventions, and success rates were investigated from the patients’ files, retrospectively. RESULTS: The mean postoperative follow-up time was 16.4±7.5 mo. The preoperative mean corrected intraocular pressure(IOP) was 28.7±10.3 mm Hg and postoperative mean corrected IOP was 15.3±5.2 mm Hg(P<0.05) at the last visit. The mean IOP reduction was 39.9% when the preoperative and postoperative values of the last visits were compared. The average number of antiglaucomatous drug use decreased from 3.9±0.3 to 1.7±1.7 postoperatively(P<0.05). The use of antiglaucomatous medications at the last visit was more than in other studies in the literature. The most common complication was conjunctival leakage, which was seen in 7 patients. Other early complications were iris touch, intravitreal hemorrhage, hyphema, choroidal effusion, early transient hypotonia and corneal edema. One of the late complications was endophthalmitiswhich was seen in one case 6 mo after the operation, and the other late complication was opacification of the cornea in one patient. Twelve additional surgical operations associated to Ex-PRESS surgery and 3 bleb needling have done. At the last visit, the complete success rate was 32.3% and the qualified success rate was 77.5% in all patients. CONCLUSION: Ex-PRESS P200 glaucoma shunt implantation may be an effective procedure for medically uncontrolled glaucoma with significantly lower use of antiglaucomatous medications.展开更多
AIM：To systematically review the current evidence based on the efficacy and cost of Ex-PRESS implantation and trabeculectomy（Trab）for uncontrolled glaucoma.·METHODS：Clinical trials were identified by electron...AIM：To systematically review the current evidence based on the efficacy and cost of Ex-PRESS implantation and trabeculectomy（Trab）for uncontrolled glaucoma.·METHODS：Clinical trials were identified by electronic databases（Pub Med,EMBASE,ISI Web of science and Cochrane library）,and data,such as intraocular pressure（IOP）,the complete and qualified success rate,the postoperative complications and the cost,were exacted from these relevant studies.Weighted mean difference（WMD）,odds ratio（OR）and 95%confidence intervals（CIs）were calculated and were pooled using a randomeffects model.·RESULTS：Eleven relevant publications and two abstracts met the inclusion criteria.The efficacy of ExPRESS was similar to that of Trab in the percentage of IOP reduction（IOPR%）at 1,2y（WMD：-2.01;95%CI：-7.92-3.90;=0.50 and WMD：2.89;95%CI：-8.05-13.83;=0.60,respectively）.Ex-PRESS possessed a significant higher complete and qualified success rate（OR：1.59;95%CI：1.07-2.35;=0.02 and OR：1.74;95%CI：1.06-2.86;=0.03,respectively）.Moreover,Ex-PRESS exerted a significantly lower frequency of hypotony and hyphema than Trab（OR：0.39;95%CI：0.21-0.72;=0.003 and OR：0.27;95%CI：0.10-0.69;=0.003,respectively）.However,there was no consistent result on the cost between the two groups according to the previous three studies.·C ONCLUSION：Both Trab and Ex-PRESS have equivalent efficacy in lowering IOP,yet Ex-PRESS had a lower risk of hypotony and hyphema than Trab.Nevertheless,whether the cost of Ex-PRESS was less than that of Trab should be further investigated to ensure evidence-based conclusion in the long run.展开更多
AIM: To compare the outcome of an Ex-Press implant and subscleral trabeculectomy(SST) in the management of glaucoma after previous trabeculectomy on a fibrotic bleb.METHODS: This randomized prospective study included ...AIM: To compare the outcome of an Ex-Press implant and subscleral trabeculectomy(SST) in the management of glaucoma after previous trabeculectomy on a fibrotic bleb.METHODS: This randomized prospective study included 28 eyes from 28 patients(age range: 42-55 y) with primary open angle glaucoma(POAG) presented with elevated intraocular pressure(IOP) with fibrotic bleb despite previous SST for more than 4 mo. The eyes enrolled in the study were divided into two groups: group I(subjected to Ex-Press implant surgery) and group II [subjected to SST with mitomycin C(MMC)]. The follow-up continued one year after surgery to evaluate IOP, visual acuity(VA), visual field(VF), and postoperative complications. RESULTS: A significant decrease in IOP was found in both groups with a higher reduction in Ex-Press implant surgery with the mean IOP of 14.50 mm Hg(P=0.001), while the SST group recorded the mean IOP of 16.50 mm Hg(P=0.001) after one year. However, the difference between the two groups in terms of the decrease in IOP was insignificant. Fewer postoperative complications were recorded in the Ex-Press implant surgery and more cases requiring further anti-glaucomatous medications were seen in the SST group. Both groups showed stability in terms of VA and VF.CONCLUSION: Ex-Press implant surgery and SST with MMC are two surgical alternatives for controlling IOP in late failure that occurs more than 4 mo after previous SST with a fibrotic bleb. However, Ex-Press shunt is a safer surgery with fewer complications.展开更多
基金Supported by the Key Laboratory Program of Shandong Eye Institute(No.2014-1)Medicine Science and Technology Development Program,Shandong,China(No.2015WS0204)+1 种基金the Science and Technology plan of Qingdao,China(No.15-9-1-35-jch)the Innovation Project of Shandong Academy of Medical Sciences
文摘AIM： To compare the long-term outcomes of the Ex-PRESS miniature glaucoma device implanted under a scleral flap in combination of phacoemulsification with intraocular lens implantation in primary open angle glaucoma （POAG） and chronic primary angle-closure glaucoma （CPACG）.METHODS： Retrospective, comparative study. A total of 60 eyes （60 patients） receiving the Ex-PRESS miniature glaucoma device implantation combined with phacoemulsification were reviewed. Thirty eyes （30 patients） had the combined procedures for POAG, and the other 30 eyes （30 patients） for CPACG. RESULTS： The follow-up was 39.37±7.09mo （range 3 to 49mo） in patients with POAG and 37.10±9.26mo （range 9 to 49mo） in patients with CPACG （P=0.29）. The mean change in best corrected visual acuity was 0.41 logMAR for POAG and 0.38 logMAR for CPACG at the last follow-up （P=0.22）. The postoperative intraocular pressure （IOP） of the POAG group was significantly lower than the CPACG group at 1, 3, 12, and 18mo after surgery （P=0.02, 0.00, 0.04, 0.01） with similar glaucoma medications after surgery （P〉0.16）. At 3y after surgery, the cumulative complete and qualified success rates were 63.3% （POAG） and 53.3% （CPACG）, 83.3% （POAG） and 73.3% （CPACG） （P=0.41, 0.49）, respectively. The POAG group had more hypotony than the CPACG group （P=0.04）.CONCLUSION： The long-term outcomes show the Ex-PRESS implantation combined with phacoemulcification can effectively lower the IOP in both the POAG and CPACG groups. The POAG group seems to have lower postoperative IOP and a higher risk of hypotony.
文摘AIM：To compare the surgical outcomes of trabeculectomy with Ex-PRESS implant and Ahmed glaucoma valve（AGV） implantation. METHODS： Patients who underwent trabeculectomy with Ex-PRESS implants or AGV implantation separately were included in this retrospective chart review.Main outcome measures were surgical failure and complications.Failure was defined as intraocular pressure（IOP） 〉21 mm Hg or 〈5 mm Hg on two consecutive visits after 3mo,reoperation for glaucoma,or loss of light perception.Eyes that had not failed were considered as complete success if they did not required supplemental medical therapy.RESULTS： A total of 64 eyes from 57 patients were included： 31 eyes in the Ex-PRESS group and 33 eyes in the AGV group.The mean follow-up time was 2.6 ±1.1y and 3.3±1.6y,respectively.Patients in the AGV group had significantly higher baseline mean IOP（P =0.005）,lower baseline mean visual acuity（VA）（P =0.02）,and higher proportion of patients with history of previous trabeculectomy（P 〈0.0001）.Crude failure rates were 16.1%,n =5/31 in the Ex-PRESS group and 24.2%,n =8/33 in the AGV group.The cumulative proportion of failure was similar between the groups,P =0.696.The proportion of eyes that experienced postoperative complications was32.3% in the Ex-PRESS group and 60.1% in the AGV group（P =0.0229）.CONCLUSION： Trabeculectomy with Ex-PRESS implant and AGV implantation had comparable failure rates.The AGV group had more post-operative complications,but also included more complex cases with higher baselinemean IOP,worse baseline mean VA,and more previous glaucoma surgeries.Therefore,the results are limited to the cohort included in this study.
文摘AIM: To evaluate the clinical results, efficacy and safety of Ex-PRESS P200 glaucoma shunt implant in different types of medically uncontrolled glaucoma. METHODS: The study included 31 eyes of 31 patients that were unresponsive to medical antiglaucomatous therapy in whom Ex-PRESS P200 glaucoma shunt implantation was performed. The demographic characteristics of the patients, type of glaucoma, complete ocular examination results, number of antiglaucomatous drugs before and after surgery, early and late complications of surgery, additional surgical and nonsurgical medical interventions, and success rates were investigated from the patients’ files, retrospectively. RESULTS: The mean postoperative follow-up time was 16.4±7.5 mo. The preoperative mean corrected intraocular pressure(IOP) was 28.7±10.3 mm Hg and postoperative mean corrected IOP was 15.3±5.2 mm Hg(P<0.05) at the last visit. The mean IOP reduction was 39.9% when the preoperative and postoperative values of the last visits were compared. The average number of antiglaucomatous drug use decreased from 3.9±0.3 to 1.7±1.7 postoperatively(P<0.05). The use of antiglaucomatous medications at the last visit was more than in other studies in the literature. The most common complication was conjunctival leakage, which was seen in 7 patients. Other early complications were iris touch, intravitreal hemorrhage, hyphema, choroidal effusion, early transient hypotonia and corneal edema. One of the late complications was endophthalmitiswhich was seen in one case 6 mo after the operation, and the other late complication was opacification of the cornea in one patient. Twelve additional surgical operations associated to Ex-PRESS surgery and 3 bleb needling have done. At the last visit, the complete success rate was 32.3% and the qualified success rate was 77.5% in all patients. CONCLUSION: Ex-PRESS P200 glaucoma shunt implantation may be an effective procedure for medically uncontrolled glaucoma with significantly lower use of antiglaucomatous medications.
基金Supported by the National Natural Science Foundation of China(No.81373826)
文摘AIM：To systematically review the current evidence based on the efficacy and cost of Ex-PRESS implantation and trabeculectomy（Trab）for uncontrolled glaucoma.·METHODS：Clinical trials were identified by electronic databases（Pub Med,EMBASE,ISI Web of science and Cochrane library）,and data,such as intraocular pressure（IOP）,the complete and qualified success rate,the postoperative complications and the cost,were exacted from these relevant studies.Weighted mean difference（WMD）,odds ratio（OR）and 95%confidence intervals（CIs）were calculated and were pooled using a randomeffects model.·RESULTS：Eleven relevant publications and two abstracts met the inclusion criteria.The efficacy of ExPRESS was similar to that of Trab in the percentage of IOP reduction（IOPR%）at 1,2y（WMD：-2.01;95%CI：-7.92-3.90;=0.50 and WMD：2.89;95%CI：-8.05-13.83;=0.60,respectively）.Ex-PRESS possessed a significant higher complete and qualified success rate（OR：1.59;95%CI：1.07-2.35;=0.02 and OR：1.74;95%CI：1.06-2.86;=0.03,respectively）.Moreover,Ex-PRESS exerted a significantly lower frequency of hypotony and hyphema than Trab（OR：0.39;95%CI：0.21-0.72;=0.003 and OR：0.27;95%CI：0.10-0.69;=0.003,respectively）.However,there was no consistent result on the cost between the two groups according to the previous three studies.·C ONCLUSION：Both Trab and Ex-PRESS have equivalent efficacy in lowering IOP,yet Ex-PRESS had a lower risk of hypotony and hyphema than Trab.Nevertheless,whether the cost of Ex-PRESS was less than that of Trab should be further investigated to ensure evidence-based conclusion in the long run.
文摘AIM: To compare the outcome of an Ex-Press implant and subscleral trabeculectomy(SST) in the management of glaucoma after previous trabeculectomy on a fibrotic bleb.METHODS: This randomized prospective study included 28 eyes from 28 patients(age range: 42-55 y) with primary open angle glaucoma(POAG) presented with elevated intraocular pressure(IOP) with fibrotic bleb despite previous SST for more than 4 mo. The eyes enrolled in the study were divided into two groups: group I(subjected to Ex-Press implant surgery) and group II [subjected to SST with mitomycin C(MMC)]. The follow-up continued one year after surgery to evaluate IOP, visual acuity(VA), visual field(VF), and postoperative complications. RESULTS: A significant decrease in IOP was found in both groups with a higher reduction in Ex-Press implant surgery with the mean IOP of 14.50 mm Hg(P=0.001), while the SST group recorded the mean IOP of 16.50 mm Hg(P=0.001) after one year. However, the difference between the two groups in terms of the decrease in IOP was insignificant. Fewer postoperative complications were recorded in the Ex-Press implant surgery and more cases requiring further anti-glaucomatous medications were seen in the SST group. Both groups showed stability in terms of VA and VF.CONCLUSION: Ex-Press implant surgery and SST with MMC are two surgical alternatives for controlling IOP in late failure that occurs more than 4 mo after previous SST with a fibrotic bleb. However, Ex-Press shunt is a safer surgery with fewer complications.
