Factors influencing the filtration-bleb volume after Ex-PRESS ®  surgery

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Abstract

Purpose

The aim of this study was to investigate the factors influencing the volume of the filtration bleb after Ex-PRESS ^® surgery.

Methods

This was a retrospective non-randomized study. After excluding patients who had undergone an additional glaucoma surgery, 99 glaucoma patients who underwent Ex-PRESS ^® surgeries and were followed up for >2 years were analyzed. We used anterior segment optical coherence tomography to measure the bleb volume, and compared the volume at 1 year with that at 2 years after surgery. We also examined potential influencing factors, including age, number of medications, central corneal thickness, type of glaucoma, preoperative intraocular pressure (IOP), postoperative IOP, reduction ratio of IOP, history of trabeculotomy, and operation method (Ex-PRESS ^® surgery only or simultaneous cataract surgery).

Results

Ex-PRESS ^® surgeries significantly decreased the IOP from 26.3±9.7 mmHg to 11.6±3.7 mmHg after 24 months ( P<0.001). The success rate at 2 years was 81.2% (IOP ≥21 mmHg or ≥20% reduction from the baseline IOP). The results showed that age, postoperative IOP, glaucoma type, and simultaneous cataract surgeries influenced the filtration-bleb volume.

Conclusion

Advanced age, higher postoperative IOP, pseudo-exfoliation glaucoma, and simultaneous cataract surgeries were all found to decrease the volume of the filtration bleb.

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Most cited references 25

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A twenty-year follow-up study of trabeculectomy: risk factors and outcomes.

John Landers, Keith Martin, Nicholas Sarkies … (2012)

This study was undertaken to determine the performance of trabeculectomy surgery over a 20-year period and examine the associations between outcome and risk factors for trabeculectomy failure. Retrospective cohort study. A total of 234 patients (330 procedures) who had undergone trabeculectomy surgery at Addenbrooke's Hospital, Cambridge, United Kingdom, between January 1988 and December 1990. Patients were identified through surgical logbooks (n = 521 procedures on 380 patients); after this, a case-note review was undertaken, which identified 234 patients (330 procedures) who had available case notes. Surgical success was defined as "complete success" while intraocular pressure (IOP) remained <21 mm Hg with no additional medication and as "qualified success" if those requiring additional topical medication were included. Functional success was defined if patients did not progress to legal blindness (visual acuity <3/60 or visual field <10 degrees). After 20 years, 57% were classified as complete success, 88% were classified as qualified success, and 15% had become blind. Those at risk of trabeculectomy failure were younger or had uveitic glaucoma. Those with pseudoexfoliation or aphakia were more likely to progress to blindness. Furthermore, those using 2 or more topical medications or with advanced visual field loss at the time of surgery were more at risk of both trabeculectomy failure and blindness. This study indicates that trabeculectomy survival at 20 years may be approximately 60% with no topical medication and approximately 90% with additional topical medication. Patient age, preoperative topical medication use, glaucoma type, and glaucoma severity will independently influence this outcome. Trabeculectomy surgery is therefore a long-term solution to IOP control. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

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Randomized, prospective, comparative trial of EX-PRESS glaucoma filtration device versus trabeculectomy (XVT study).

Mark Sherwood, Matthew R Sarkisian, A. G. Condon … (2014)

To compare the clinical outcomes of the EX-PRESS glaucoma filtration device placed under a partial-thickness scleral flap with trabeculectomy. Randomized, prospective, multicenter trial. A total of 120 eyes in 120 subjects were analyzed, including 59 eyes treated with EX-PRESS and 61 eyes treated with trabeculectomy. Both the EX-PRESS and the trabeculectomy groups were treated intraoperatively with mitomycin C and followed postoperatively for 2 years. Surgical success was defined as 5 mm Hg ≤ intraocular pressure ≤ 18 mm Hg, with or without medications, without further glaucoma surgery. Mean intraocular pressure was significantly reduced compared with baseline in both groups (P < 0.001). Average intraocular pressure and number of medications were similar in both groups during follow-up, with mean intraocular pressure at 2 years after surgery of 14.7 ± 4.6 mm Hg and 14.6 ± 7.1 mm Hg in the EX-PRESS and trabeculectomy groups, respectively (P = 0.927). At 2 years after surgery, the success rate was 83% and 79% in the EX-PRESS and trabeculectomy groups, respectively (P = 0.563). Although visual acuity (logMAR) was significantly decreased on day 1 in both groups, the vision was not significantly different compared with baseline at 1 month after EX-PRESS implant (P = 0.285) and 3 months after trabeculectomy (P = 0.255). The variance of early postoperative intraocular pressure values was similar between groups on the first postoperative day but higher after trabeculectomy compared with EX-PRESS implant on day 7 (P = 0.003). The total number of postoperative complications was higher after trabeculectomy than after EX-PRESS implantation (P = 0.013). Mean intraocular pressures, medication use, and surgical success were similar at 2 years after treatment with the EX-PRESS device and trabeculectomy. Vision recovery between groups was also similar throughout the study, although return to baseline vision was more rapid in the EX-PRESS group. Intraocular pressure variation was lower during the early postoperative period, and postoperative complications were less common after EX-PRESS implantation compared with trabeculectomy. Copyright © 2014 Elsevier Inc. All rights reserved.

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Long-term morphologic effects of antiglaucoma drugs on the conjunctiva and Tenon's capsule in glaucomatous patients.

Joseph Sherwood, I Grierson, Neal Millar … (1989)

Conjunctival and Tenon's capsule biopsies from two patient groups were quantitatively analyzed by light microscopy. Group A consisted of 20 patients with a primary glaucoma for whom surgery was a planned primary treatment modality. Group B was comprised of 20 patients with a primary glaucoma who had received at least two types of antiglaucoma topical medication, for a minimum of 1 year (mean, 7.7 years) before surgery. All slides were examined by two masked observers. A significant increase in the number of macrophages, lymphocytes, mast cells, and fibroblasts in the conjunctiva and Tenon's capsule and a significant decrease in the number of epithelial goblet cells were seen in the group that received long-term drop therapy. These results suggest that exhaustive medical therapy, before surgery is offered, increases the number of tissue inflammatory cells. It is possible this may enhance the risk of external bleb scarring and filtration surgery failure.

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Author and article information

Journal

Journal ID (nlm-ta): Clin Ophthalmol

Journal ID (iso-abbrev): Clin Ophthalmol

Journal ID (publisher-id): Clinical Ophthalmology

Title: Clinical Ophthalmology (Auckland, N.Z.)

Publisher: Dove Medical Press

ISSN (Print): 1177-5467

ISSN (Electronic): 1177-5483

Publication date Collection: 2018

Publication date (Electronic): 05 September 2018

Volume: 12

Pages: 1675-1683

Affiliations

Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan, tojo-naoki@ 123456umin.ac.jp

Author notes

Correspondence: Naoki Tojo, Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama City 930-0194, Japan, Tel +81 76 434 7363, Fax +81 76 434 5037, Email tojo-naoki@ 123456umin.ac.jp

Article

Publisher ID: opth-12-1675

DOI: 10.2147/OPTH.S172400

PMC ID: 6134405

PubMed ID: 30233131

SO-VID: e21d9a0d-213e-4edd-b40f-d53e7c77449b

License:

The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

Factors influencing the filtration-bleb volume after Ex-PRESS ^® surgery

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Abstract

Purpose

Methods

Results

Conclusion

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Karger: Ophthalmology

Most cited references 25

A twenty-year follow-up study of trabeculectomy: risk factors and outcomes.

Randomized, prospective, comparative trial of EX-PRESS glaucoma filtration device versus trabeculectomy (XVT study).

Long-term morphologic effects of antiglaucoma drugs on the conjunctiva and Tenon's capsule in glaucomatous patients.

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