Ex-PRESS implantation versus trabeculectomy in uncontrolled glaucoma: a meta-analysis.

Abstract

OBJECTIVE:

To evaluate the efficacy and tolerability of Ex-PRESS implantation (Ex-Press) compared with trabeculectomy (Trab) in the treatment of patients with uncontrolled glaucoma.

METHODS:

A comprehensive literature meta-analysis was performed according to the Cochrane Collaboration methodology to identify controlled clinical trials comparing Ex-Press with Trab. Efficacy estimates were measured by weight mean difference (WMD) for the percentage intraocular pressure (IOP) reduction from baseline to end-point, odds ratio (OR) for complete success, and qualified success rates. Tolerability estimates were measured by OR for adverse events. All outcomes were reported with a 95% confidence interval (CI). Data were synthesized by Stata 11.0 SE for Windows.

RESULTS:

Eight controlled clinical trials meeting the predefined criteria were included in the meta-analysis. A total of 605 eyes from 559 patients with medically uncontrolled glaucoma were included. The weighted mean difference of the percentage IOP reduction from baseline was 2.33 (95% confidence interval: -2.59-7.24) when comparing Ex-Press with Trab. Ex-Press was associated with numerically greater, but nonsignificant, IOP lowering efficacy than Trab. The pooled odds ratio comparing Ex-Press with Trab were 0.93 (0.39, 2.23) for the complete success rate and 1.00 (0.39, 2.56) for the qualified success rate. Ex-Press was associated with a significantly lower frequency of hypotony and hyphema than Trab, with pooled ORs of 0.29 (0.13, 0.65) and 0.36 (0.13, 0.97), respectively.

CONCLUSION:

Ex-Press was associated with equivalent efficacy to Trab in lowering IOP. Comparable proportions of patients reached the IOP target with Ex-Press and Trab. Ex-Press was better tolerated than Trab.

• Authors: Wei Wang, Minwen Zhou, Wenbin Huang, Xiulan Zhang
• Journal: PloS one (PLoS One) Vol. 8 Issue 5 Pg. e63591 ( 2013) ISSN: 1932-6203 [Electronic] United States
• PMID: 23741296 (Publication Type: Comparative Study, Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Conjunctiva (surgery)
• Controlled Clinical Trials as Topic
• Databases, Bibliographic
• Female
• Glaucoma (diagnosis, pathology, surgery)
• Glaucoma Drainage Implants
• Humans
• Intraocular Pressure
• Male
• Middle Aged
• Odds Ratio
• Sclera (surgery)
• Tonometry, Ocular
• Trabeculectomy
• Treatment Outcome