title: Assessment of bleb morphologic features and postoperative outcomes after Ex-PRESS drainage device implantation versus trabeculectomy.
abstract: OBJECTIVE
  To investigate bleb morphologic features and postoperative outcomes after Ex-PRESS drainage device (Alcon Laboratories) implantation versus trabeculectomy.
  
  
  METHODS
  Retrospective, consecutive case-control series.
  
  
  METHODS
  Information was collected from the charts of 35 consecutive Ex-PRESS procedures and 35 consecutive trabeculectomy procedures with at least 2 years of follow-up. Intraocular pressure (IOP), bleb morphologic features, reduction of dependence on medication, visual recovery, number of postoperative visits, and postoperative complication rates were compared between groups.
  
  
  RESULTS
  Average follow-up was 28 months (standard deviation, 3.23 months). Mean IOP measurements were similar after 6 months, then became slightly higher in the Ex-PRESS group at 1 year and at the final follow-up (P = .004 and P = .008, respectively). Final percent IOP lowering was similar between groups (P = .209). Unqualified success was achieved in 77.14% of Ex-PRESS and 74.29% of trabeculectomy procedures at last follow-up (P = 1.00). An additional 5.71% and 8.57% reached qualified success for Ex-PRESS and trabeculectomy surgeries, respectively (P = .99). Evaluation by the Moorfields Bleb Grading System revealed less vascularity and height but more diffuse area associated with the Ex-PRESS blebs, although these differences were absent at study completion. There were fewer cases of early postoperative hypotony and hyphema and quicker visual recovery in the Ex-PRESS group. The Ex-PRESS group required fewer postoperative visits compared with the trabeculectomy group (P < .000).
  
  
  CONCLUSIONS
  Success of Ex-PRESS surgery, as defined in our study, was similar to trabeculectomy. Final IOP measurements were slightly lower after trabeculectomy compared with Ex-PRESS. Differences in some postoperative outcomes faded with follow-up. There remains a need for long-term prospective studies comparing these 2 procedures.
authors.affiliation: Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado 80045, USA.
authors.forename: Travis J
authors.initials: TJ
authors.lastname: Good
authors.forename: Malik Y
authors.initials: MY
authors.lastname: Kahook
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage; D016022:Case-Control Studies; D003228:Conjunctiva / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D011183:Postoperative Complications; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D019738:Surgically-Created Structures / Q000473:pathology*; D014130:Trabeculectomy; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000959:Antihypertensive Agents