title: Ex-PRESS implantation versus trabeculectomy in uncontrolled glaucoma: a meta-analysis.
abstract: OBJECTIVE
  To evaluate the efficacy and tolerability of Ex-PRESS implantation (Ex-Press) compared with trabeculectomy (Trab) in the treatment of patients with uncontrolled glaucoma.
  
  
  METHODS
  A comprehensive literature meta-analysis was performed according to the Cochrane Collaboration methodology to identify controlled clinical trials comparing Ex-Press with Trab. Efficacy estimates were measured by weight mean difference (WMD) for the percentage intraocular pressure (IOP) reduction from baseline to end-point, odds ratio (OR) for complete success, and qualified success rates. Tolerability estimates were measured by OR for adverse events. All outcomes were reported with a 95% confidence interval (CI). Data were synthesized by Stata 11.0 SE for Windows.
  
  
  RESULTS
  Eight controlled clinical trials meeting the predefined criteria were included in the meta-analysis. A total of 605 eyes from 559 patients with medically uncontrolled glaucoma were included. The weighted mean difference of the percentage IOP reduction from baseline was 2.33 (95% confidence interval: -2.59-7.24) when comparing Ex-Press with Trab. Ex-Press was associated with numerically greater, but nonsignificant, IOP lowering efficacy than Trab. The pooled odds ratio comparing Ex-Press with Trab were 0.93 (0.39, 2.23) for the complete success rate and 1.00 (0.39, 2.56) for the qualified success rate. Ex-Press was associated with a significantly lower frequency of hypotony and hyphema than Trab, with pooled ORs of 0.29 (0.13, 0.65) and 0.36 (0.13, 0.97), respectively.
  
  
  CONCLUSIONS
  Ex-Press was associated with equivalent efficacy to Trab in lowering IOP. Comparable proportions of patients reached the IOP target with Ex-Press and Trab. Ex-Press was better tolerated than Trab.
authors.affiliation: Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Minwen
authors.initials: M
authors.lastname: Zhou
authors.forename: Wenbin
authors.initials: W
authors.lastname: Huang
authors.forename: Xiulan
authors.initials: X
authors.lastname: Zhang
mesh_terms: D000368:Aged; D003228:Conjunctiva / Q000601:surgery; D018849:Controlled Clinical Trials as Topic; D016206:Databases, Bibliographic; D005260:Female; D005901:Glaucoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012590:Sclera / Q000601:surgery; D014065:Tonometry, Ocular; D014130:Trabeculectomy; D016896:Treatment Outcome