Efficacy and safety of Ex-PRESS? mini shunt surgery versus trabeculectomy for neovascular glaucoma: a retrospective comparative study

摘要

The objective of this study is to evaluate and compare the short-term efficacy and safety of Ex-PRESS? mini shunt surgery and trabeculectomy for neovascular glaucoma (NVG). Patients with NVG who underwent Ex-PRESS? mini shunt surgery or trabeculectomy as a primary glaucoma surgery between March 2013 and October 2015 were included in the study, and their medical charts were retrospectively reviewed. The Ex-PRESS? and trabeculectomy groups included 14 eyes and 30 eyes, respectively. Surgical failure was defined by an intraocular pressure (IOP) of ≥21?mmHg (condition A) or?≥?18?mmHg (condition B); Kaplan–Meier survival analyses and the multivariable Cox proportional hazards model were used to assess efficacies. Kaplan–Meier survival analyses indicated that the probabilities of success at 1?year for the Ex-PRESS? group were 25.7 and 31.8% based on complete and qualified success under condition A, respectively. The corresponding values for the trabeculectomy group were 47.8 and 69.3%, and there was a significant difference in qualified success with condition A (Fig.?1; P?=?0.018), while there were no significant differences in the other criteria. Ex-PRESS? mini shunt surgery and higher intraocular pressure were independent prognostic factors using Cox proportional hazards model analyses in qualified success as in condition A (P?=?0.012 and 0.0495, respectively). The occurrences of postsurgical hyphema and bleb leaks were significantly higher in the trabeculectomy group (P?=?0.005 and 0.008, respectively). During a 1?year follow-up, Ex-PRESS? mini shunt surgery was a less effective, but safer treatment for NVG compared with trabeculectomy.