Standard Trabeculectomy and Ex-PRESS Miniature Glaucoma Shunt: A Comparative Study and Literature Review

PURPOSE The aim of this study was to compare the efficacy and safety between standard trabeculectomy and the Ex-PRESS shunt implantation. METHODS A retrospective review of the records of 100 eyes of 100 patients who underwent trabeculectomy or Ex-PRESS shunt implantation between July 2010 and June 2012 was conducted. Of these, 61 (61%) eyes underwent trabeculectomy and 39 (39%) eyes underwent Ex-PRESS shunt implantation. Demographic information, glaucoma type, surgical details, preoperative, and postoperative data including intraocular pressure (IOP), number of medications, reoperation, and occurrence of any complications were recorded. RESULTS No differences in IOP reduction or number of postoperative IOP-lowering medications were demonstrated between the 2 procedures. Success rates were 86.9% for trabeculectomy and 84.6% for Ex-PRESS shunt. Rates of failure and hypotony were not significantly different between the groups. No parameter was correlated with success or failure of any procedure. CONCLUSIONS Standard trabeculectomy and Ex-PRESS shunt have similar efficacy and safety profiles. As the Ex-PRESS shunt is considerably more expensive, its use may be unjustified, especially as a primary procedure.