Liu Jia-Houng, Lin Hung-Yu, Tzeng Shih-Hao, Chao Shih-Chun
Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan.
Institute of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan.
Taiwan J Ophthalmol. 2015 Jul-Sep;5(3):120-123. doi: 10.1016/j.tjo.2015.04.004. Epub 2015 Jun 13.
To investigate the efficacy of intraocular pressure (IOP) control and medication use over time after trabeculectomy (TRBC) and Ex-PRESS shunt implantation in primary-open-angle-glaucoma (POAG) patients.
Retrospective case series.
A total of 33 unilateral POAG patients were enrolled, and 17 patients received traditional TRBC and 16 patients received Ex-PRESS device implantation. Data on IOP, reduction of antiglaucoma medication, and major complications were collected and analyzed after 12 months of follow up.
After 12 months of follow up, both groups showed good IOP control. The mean preoperative IOP decreased from 38.5 (±6.9) to 18.2 (±11) mmHg after TRBC, and from 38.5 (±9.1) to 19.53 (±12.36) mmHg after Ex-PRESS implantation (both < 0.05). The mean number of antiglaucoma medications prescribed at the last follow up decreased from 3.2 (±0.5) preoperatively to 1.2 (±1.4) after TRBC versus 3.3 (±0.7) preoperatively to 1 (±0.9) after Ex-PRESS implantation (both < 0.05). Complete success rate (defined as no medication after surgery with IOP >5 and <18 mmHg) and qualified success rate (defined as with or without medication after surgery with IOP >5 and <18 mmHg) were similar (47% vs. 43% and 76.47% vs. 75%) between the two groups without statistical difference ( > 0.05). However, postoperative hypotony rate was more frequent after Ex-PRESS (37.5%) than after TRBC (17.64%).
TRBC and Ex-PRESS implantation provided similar IOP control and reduction of postoperative medication with low incidence of postoperative complications at intermediate-term follow up. However, the Ex-PRESS implantation device may last longer but with extra costs. It is up to the surgeon to decide which procedure to use according to the patient's situation and economic circumstances.
探讨小梁切除术（TRBC）和植入Ex-PRESS分流器后，原发性开角型青光眼（POAG）患者眼压（IOP）控制效果及药物使用随时间的变化情况。
回顾性病例系列研究。
共纳入33例单侧POAG患者，其中17例接受传统小梁切除术，16例接受Ex-PRESS装置植入术。随访12个月后，收集并分析眼压、抗青光眼药物使用减少情况及主要并发症的数据。
随访12个月后，两组眼压控制均良好。小梁切除术后，术前平均眼压从38.5（±6.9）mmHg降至18.2（±11）mmHg；Ex-PRESS植入术后，术前平均眼压从38.5（±9.1）mmHg降至19.53（±12.36）mmHg（均P<0.05）。末次随访时，小梁切除术前抗青光眼药物平均处方数从3.2（±0.5）降至1.2（±1.4），Ex-PRESS植入术前从3.3（±0.7）降至1（±0.9）（均P<0.05）。两组的完全成功率（定义为术后无需用药且眼压>5且<18 mmHg）和合格成功率（定义为术后用药与否且眼压>5且<18 mmHg）相似（47%对43%，76.47%对75%），无统计学差异（P>0.05）。然而，Ex-PRESS植入术后低眼压发生率（37.5%）高于小梁切除术（17.64%）。
小梁切除术和Ex-PRESS植入术在中期随访中眼压控制效果及术后药物使用减少情况相似，术后并发症发生率低。然而，Ex-PRESS植入装置可能持续时间更长，但费用更高。应由外科医生根据患者情况和经济状况决定采用哪种手术方式。
