Short-term outcomes after EX-PRESS implantation versus trabeculectomy alone in patients with neovascular glaucoma

Figures & data

Table 1 Baseline demographic and clinical characteristics of 89 patients with neovascular glaucoma

Characteristics	Trabeculectomy	EX-PRESS	P-value
	(N=39), n (%)	(N=50), n (%)
Sex			0.276
Male	27 (69.2)	29 (58.0)
Female	12 (30.8)	21 (42.0)
Age (years)			0.699
Mean ± SD	63.5±15.4	62.2±11.6
Range	21–90	41–83
Etiology
DR	24 (61.5)	44 (88.0)
OIS	7 (17.9)	2 (4.0)
RVO	4 (10.3)	4 (8.0)
RAO	2 (5.1)	0 (0)
Others	2 (5.1)	0 (0)
Preoperative IVB (<1 month)	26 (66.7)	29 (58.0)	0.404

Abbreviations: DR, diabetic retinopathy; IVB, intravitreal bevacizumab; OIS, ocular ischemic syndrome; RAO, retinal artery occlusion; RVO, retinal vein occlusion.

Figure 1 Preoperative and postoperative clinical outcomes comparing trabeculectomy alone and EX-PRESS implantation.

Notes: (A) Mean IOP was significantly reduced in both groups before and after surgery. At week 1, IOP was significantly lower in the Trab group than in the EX group (P=0.045). (B) Visual acuity (logMAR) after EX-PRESS implantation and trabeculectomy alone. There was no significant difference at any time point between the two groups. (C) Mean number of antiglaucoma medications was significantly lower before and after surgery in both groups. There were no significant differences between the groups at baseline and at the final visit time points. The data are expressed as mean ± SD. (D) Kaplan–Meier survival analysis after EX-PRESS implantation versus trabeculectomy alone. Success was defined as 5 mmHg ≤ IOP ≤21 mmHg, with or without medications. Failure was defined as follows: two consecutive IOP measurements outside the above-mentioned range 2 weeks after glaucoma surgery, repeat glaucoma surgery, or worsening of best-corrected visual acuity to no light perception. Survival rate did not differ significantly between the two groups (P=0.51). *P<0.05.
Abbreviations: D, day; EX, EX-PRESS implantation; IOP, intraocular pressure; logMAR, logarithm of the minimum angle of resolution; M, month; Trab, trabeculectomy alone; W, week.

Table 2 Postoperative complications after trabeculectomy alone and after EX-PRESS implantation in patients with neovascular glaucoma

Complication	Trabeculectomy	EX-PRESS	P-value
	(N=39), n (%)	(N=50), n (%)
Early postoperative hypotony	14 (35.9)	7 (14.0)	0.016
Choroidal detachment	9 (23.1)	10 (20.0)	0.797
Hyphema	13 (33.3)	5 (10.0)	0.008
Shallow anterior chamber	7 (17.9)	1 (2.0)	0.019
Bleb leak (>6 weeks)	2 (5.1)	2 (4.0)	1
Hypotony maculopathy	1 (2.6)	0 (0)	0.438
Endophthalmitis	0 (0)	0 (0)	N/A

Abbreviation: N/A, not available.

Table 3 Additional surgical treatment after trabeculectomy alone and after EX-PRESS implantation in patients with neovascular glaucoma

Additional intervention	Trabeculectomy	EX-PRESS	P-value
	(N=39), n (%)	(N=50), n (%)
Laser suture lysis	24 (61.5)	9 (18.0)	0.859
Needling	11 (28.2)	7 (14.0)	0.116
Anterior chamber irrigation	5 (12.8)	0 (0)	0.014
Repeat surgery	2 (5.1)	1 (2.0)	0.579
Cyclophotocoagulation	2 (5.1)	1 (2.0)	0.579

Figure 2 Kaplan–Meier survival analysis of surgical outcomes in eyes that underwent EX-PRESS implantation for neovascular glaucoma.

Notes: (A) With a history of previous vitrectomy (n=15) versus without a history of previous vitrectomy (n=35; P=0.047). (B) With intravitreal bevacizumab (<1 month; n=9) versus without intravitreal bevacizumab (n=21; P=0.91). (C) Age <60 years (n=19) versus age ≥60 years (n=31; P=0.13). (D) Combined cataract surgery (n=12) versus only EX-PRESS implantation (n=38; P=0.093). *P<0.05.
Abbreviation: IVB, intravitreal bevacizumab.

Table 4 Potential predictors of surgical success in patients with neovascular glaucoma who underwent EX-PRESS implantation

Variable	Patients, n (%)	Final success rate, %	P-value
Age (<60 years)			0.13
Yes	19 (38.0)	65.2
No	31 (62.0)	85.8
Previous vitrectomy			0.047
Yes	15 (30.0)	55.4
No	35 (70.0)	81.4
Preoperative IVB (<1 month)			0.91
Yes	29 (58.0)	76.5
No	21 (42.0)	82.4
Combined cataract surgery			0.093
Yes	12 (24.0)	100.0
No	38 (76.0)	71.4

Abbreviation: IVB, intravitreal bevacizumab.