*Department of Ophthalmology and Vision Sciences, University of Toronto †Dalla Lana School of Public Health, University of Toronto, Toronto §Department of Ophthalmology, Queen's University, Kingston, ON, Canada ‡Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel.
J Glaucoma. 2015 Mar;24(3):181-6. doi: 10.1097/IJG.0b013e31829e1b68.
To compare the rate of visual recovery after Ex-PRESS implantation versus standard trabeculectomy.
Subjects enrolled in a prospective randomized controlled trial comparing Ex-PRESS to trabeculectomy were analyzed for postoperative changes in visual acuity (VA). Risk factors for visual loss (split fixation, cup-disc ratio, intraocular pressure, visual field mean deviation, and hypotony) were evaluated.
Sixty-four subjects were enrolled (33 Ex-PRESS, 31 trabeculectomy). There was no significant difference in mean logMAR VA between groups at baseline or any study visit. VA was significantly reduced up to week 2 following surgery in both the groups. However, by month 1, VA in the Ex-PRESS group was no longer significantly different from baseline (P=0.23) and remained nonsignificant at subsequent visits up to 6 months. In the trabeculectomy group, VA remained significantly lower than baseline at each study visit. At 6 months, 47% of the trabeculectomy eyes compared with 16% of the Ex-PRESS eyes had lost ≥2 Snellen lines (P=0.01). Reasons for VA loss included cataract, central retinal vein occlusion, and diabetic retinopathy, however, in a significant number of cases no cause could be determined. None of the risk factors evaluated were associated with vision loss.
Although there was no difference in mean VA between the Ex-PRESS and trabeculectomy groups at any time point, trabeculectomy eyes were more likely to lose ≥2 Snellen lines. In addition, VA recovered faster in the Ex-PRESS group.
比较 Ex-PRESS 植入术后与标准小梁切除术的视力恢复率。
对一项前瞻性随机对照试验中接受 Ex-PRESS 与小梁切除术的患者进行分析，以评估术后视力变化。评估了导致视力丧失的风险因素（裂孔性固视、杯盘比、眼内压、视野平均偏差和低眼压）。
共纳入 64 例患者（33 例 Ex-PRESS，31 例小梁切除术）。两组基线或任何研究访视点的平均对数视力均无显著差异。两组术后 2 周内视力均明显下降。然而，在 Ex-PRESS 组，术后 1 个月时视力已不再显著低于基线（P=0.23），并且在随后的 6 个月访视点上仍无显著差异。在小梁切除术组，每个研究访视点的视力仍明显低于基线。在 6 个月时，与 Ex-PRESS 组相比，47%的小梁切除术眼失去了≥2 行 Snellen 视力（P=0.01）。视力丧失的原因包括白内障、视网膜中央静脉阻塞和糖尿病性视网膜病变，但在许多情况下无法确定原因。评估的风险因素均与视力丧失无关。
尽管在任何时间点 Ex-PRESS 和小梁切除术组的平均视力均无差异，但小梁切除术眼更有可能失去≥2 行 Snellen 视力。此外，Ex-PRESS 组的视力恢复更快。
