Wagdy Faried, Mokbel Tharwat H, Elsorogy Hisham, Alnagdy Ahmed, Elfattah Dina Abd, Elhesy Abd-Elmonem A
Menofia University Hospital, Menofia University, Menofia 32511, Egypt.
Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt.
Int J Ophthalmol. 2021 Mar 18;14(3):383-387. doi: 10.18240/ijo.2021.03.08. eCollection 2021.
To compare the outcome of an Ex-Press implant and subscleral trabeculectomy (SST) in the management of glaucoma after previous trabeculectomy on a fibrotic bleb.
This randomized prospective study included 28 eyes from 28 patients (age range: 42-55y) with primary open angle glaucoma (POAG) presented with elevated intraocular pressure (IOP) with fibrotic bleb despite previous SST for more than 4mo. The eyes enrolled in the study were divided into two groups: group I (subjected to Ex-Press implant surgery) and group II [subjected to SST with mitomycin C (MMC)]. The follow-up continued one year after surgery to evaluate IOP, visual acuity (VA), visual field (VF), and postoperative complications.
A significant decrease in IOP was found in both groups with a higher reduction in Ex-Press implant surgery with the mean IOP of 14.50 mm Hg (=0.001), while the SST group recorded the mean IOP of 16.50 mm Hg (=0.001) after one year. However, the difference between the two groups in terms of the decrease in IOP was insignificant. Fewer postoperative complications were recorded in the Ex-Press implant surgery and more cases requiring further anti-glaucomatous medications were seen in the SST group. Both groups showed stability in terms of VA and VF.
Ex-Press implant surgery and SST with MMC are two surgical alternatives for controlling IOP in late failure that occurs more than 4mo after previous SST with a fibrotic bleb. However, Ex-Press shunt is a safer surgery with fewer complications.
比较Ex-Press植入物与巩膜下小梁切除术（SST）在处理既往小梁切除术后纤维化滤过泡性青光眼方面的效果。
这项随机前瞻性研究纳入了28例患者（年龄范围：42 - 55岁）的28只眼睛，这些患者患有原发性开角型青光眼（POAG），尽管之前进行了超过4个月的SST，但仍出现眼压（IOP）升高且伴有纤维化滤过泡。研究纳入的眼睛分为两组：第一组（接受Ex-Press植入物手术）和第二组[接受丝裂霉素C（MMC）辅助的SST]。术后随访持续一年，以评估眼压、视力（VA）、视野（VF）及术后并发症。
两组眼压均显著降低，Ex-Press植入物手术组眼压降低更明显，术后一年平均眼压为14.50 mmHg（P = 0.001），而SST组平均眼压为16.50 mmHg（P = 0.001）。然而，两组眼压降低幅度的差异无统计学意义。Ex-Press植入物手术术后并发症较少，SST组有更多病例需要进一步使用抗青光眼药物。两组在视力和视野方面均保持稳定。
Ex-Press植入物手术和MMC辅助的SST是控制既往SST术后超过4个月出现的晚期失败病例眼压的两种手术选择。然而，Ex-Press分流术是一种更安全、并发症更少的手术。
