An Ex-Press implant versus trabeculectomy in a fibrotic bleb with late failure after previous trabeculectomy

AIM: 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. METHODS: This randomized prospective study included 28 eyes from 28 patients (age range: 42-55y) with primary open angle glaucoma (PO...

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Main Authors: Faried Wagdy, Tharwat H. Mokbel, Hisham Elsorogy, Ahmed Alnagdy, Dina Abd Elfattah, Abd-Elmonem A. Elhesy
Format: Article
Language:English
Published: Press of International Journal of Ophthalmology (IJO PRESS) 2021-03-01
Series:International Journal of Ophthalmology
Subjects:
Online Access:http://ies.ijo.cn/en_publish/2021/3/20210308.pdf
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author Faried Wagdy
Tharwat H. Mokbel
Hisham Elsorogy
Ahmed Alnagdy
Dina Abd Elfattah
Abd-Elmonem A. Elhesy
author_facet Faried Wagdy
Tharwat H. Mokbel
Hisham Elsorogy
Ahmed Alnagdy
Dina Abd Elfattah
Abd-Elmonem A. Elhesy
author_sort Faried Wagdy
collection DOAJ
description AIM: 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. METHODS: 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. RESULTS: 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 (P=0.001), while the SST group recorded the mean IOP of 16.50 mm Hg (P=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. CONCLUSION: 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.
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spelling doaj.art-3c89b34f7d594138ad032a8dd501b4812022-12-21T22:56:48ZengPress of International Journal of Ophthalmology (IJO PRESS)International Journal of Ophthalmology2222-39592227-48982021-03-0114338338710.18240/ijo.2021.03.0820210308An Ex-Press implant versus trabeculectomy in a fibrotic bleb with late failure after previous trabeculectomyFaried Wagdy0Tharwat H. Mokbel1Hisham Elsorogy2Ahmed Alnagdy3Dina Abd Elfattah4Abd-Elmonem A. Elhesy5Tharwat H. Mokbel. Mansoura Ophthalmology Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt. tharwatmokbel@yahoo.comMansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, EgyptMansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, EgyptMansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, EgyptMansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, EgyptMansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, EgyptAIM: 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. METHODS: 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. RESULTS: 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 (P=0.001), while the SST group recorded the mean IOP of 16.50 mm Hg (P=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. CONCLUSION: 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.http://ies.ijo.cn/en_publish/2021/3/20210308.pdfex-press implanttrabeculectomyglaucomafibrotic bleb
spellingShingle Faried Wagdy
Tharwat H. Mokbel
Hisham Elsorogy
Ahmed Alnagdy
Dina Abd Elfattah
Abd-Elmonem A. Elhesy
An Ex-Press implant versus trabeculectomy in a fibrotic bleb with late failure after previous trabeculectomy
International Journal of Ophthalmology
ex-press implant
trabeculectomy
glaucoma
fibrotic bleb
title An Ex-Press implant versus trabeculectomy in a fibrotic bleb with late failure after previous trabeculectomy
title_full An Ex-Press implant versus trabeculectomy in a fibrotic bleb with late failure after previous trabeculectomy
title_fullStr An Ex-Press implant versus trabeculectomy in a fibrotic bleb with late failure after previous trabeculectomy
title_full_unstemmed An Ex-Press implant versus trabeculectomy in a fibrotic bleb with late failure after previous trabeculectomy
title_short An Ex-Press implant versus trabeculectomy in a fibrotic bleb with late failure after previous trabeculectomy
title_sort ex press implant versus trabeculectomy in a fibrotic bleb with late failure after previous trabeculectomy
topic ex-press implant
trabeculectomy
glaucoma
fibrotic bleb
url http://ies.ijo.cn/en_publish/2021/3/20210308.pdf
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