Comparison Of Micro Ex-PRESS Drainage Implantation And Complex Trabeculectomy In The Treatment Of Glaucoma

Background and objectivesGlaucoma was one of progressive optic neuropathies that were associated withelevated intraocular pressure, characteristic visual field defects following the ganglioncell apoptosis.Epidemiological data indicated that the number of glaucoma was80million by2020, including up to6million in China.With the change of the society,environment and living habits and the development of modern technology ofophthalmology, the proportion of glaucoma type in China also changed, including theprevalence of open-angle glaucoma increased. There were a lot of researches on geneof glaucoma[1][2], but the mechanism of disease genes resulting in glaucoma was notyet clear, the gene therapy was still in the experimental animals. The risk factors forglaucoma were intraocular pressure, family history, smoking, high blood pressure,diabetes, inflammatory reaction, etc., Elevated intraocular pressure was the mostpredictive risk factor for visual function damage, and was the only correction factorsof glaucoma treatment process[3]. At present the methods to reduce intraocularpressure were drugs, laser and surgery. Trabeculectomy was still the main glaucomasurgery[4]. As its long-term high failure rate and many potential complications, it wasnot the ideal operation. Research abroad in recent years had reported micro drainage device implantation treatment,with showing simple operation, less complications, ef-fective pressure reduction.We were unaware of any reported postoperative outcomeof the EX-PRESS in chinese patients.The purpose of this study was to compare theoutcome of the Ex-PRESS drainage versus trabeculectomy in open-angle glaucoma.MethodsA prospective study.53cases(55eyes) open-angle glaucoma patients withpreviously failed in the study.23cases(25eyes) were randomly divided into groupwich were treated by mini Ex-PRESS drainage implantation,the other30cases(30eyes)were treated by trabeculectomy. All of the eyes were measured the visualacuities, intraocular pressure, number of glaucoma medications, operation time,surgical success rate and complications at pre-operation,1day,1week,and1,3,6months after surgery.Results1.In Ex-PRESS group,the average IOP at1day,1week,1,3and6months aftersurgery was significant different from the preoperative level(P <0.001).2. In Ex-PRESS group and TE group,the average intraocular pressure at6months postoperatively was（17.3±1.4） mm H g,（17.5±1.1）mm Hg respectively,there had no statistically significant differences between the two groups.3. In Ex-PRESS group and TE group,the operation time was (23.5±2.3) min,(34.8±2.3) min respectively, there had statistically significant differences betweenthe two groups (P <0.001); The number of glaucoma medications was (0.3±0.6),(0.4±0.7), there had no difference between the two groups.4. In Ex-PRESS group and TE group, success rate at6months after surgery was80.0%,76.7%respectively.5.In Ex-PRESS group and TE group,total complication rates were12.0%,36.7%respectively,and there had significant differences between the two groups.(P <0.037). Conclusion1.The micro Ex-PRESS implantation can reduce intraocular pressure effectively.2.Trabeculectomy and the micro Ex-PRESS implantation provioded similar IOPcontrol.3.The micro Ex-PRESS drainage implantation had lower rates of hypotony andother post-complications compared to trabeculectomy.The first had shorter operationtime, and the higher level of security.