title: Prospective Randomized Study Comparing Ex-PRESS to Trabeculectomy: 1-Year Results.
abstract: OBJECTIVE
  To compare the efficacy and safety of the Ex-PRESS glaucoma shunt with standard trabeculectomy.
  
  
  METHODS
  Consenting patients with medically uncontrolled open-angle glaucoma were prospectively randomized to trabeculectomy or Ex-PRESS shunt both with mitomycin-C. Exclusion criteria included previous ocular surgery with the exception of clear cornea phaco or 1 previous trabeculectomy, uveitis, and vitreous in the anterior chamber. Standardized data collection sheets were completed at baseline and postoperative day 1, weeks 1 and 2, and months 1, 2, 3, 6, and 12. Primary outcome was intraocular pressure (IOP). Complete success was defined as an IOP between 5 and 18 mm Hg and a 20% reduction from baseline without medication. A sample size calculation determined that 52 eyes were required to detect a 2.0 mm Hg IOP difference with a power of 80%.
  
  
  RESULTS
  Sixty-four subjects were enrolled, 33 in the Ex-PRESS and 31 in the trabeculectomy group. IOP was not statistically significantly different between groups. Baseline and 1-year mean IOP was 22.0±6.8 versus 22.7±10.3 mm Hg (P=0.76) and 11.6±4.5 versus 11.3±4.5 mm Hg (P=0.81) in the trabeculectomy versus Ex-PRESS groups, respectively. Complete success was 57% versus 70% (P=0.28) in the trabeculectomy versus Ex-PRESS groups, respectively. There were no statistically significant differences in surgical time, number of glaucoma medications, visual acuity, central corneal thickness, endothelial cell counts, complications, interventions, or bleb morphology between the trabeculectomy and the Ex-PRESS groups.
  
  
  CONCLUSIONS
  There was no statistically significant difference between the trabeculectomy and Ex-PRESS groups regarding IOP, success rates, complications, additional interventions, and bleb morphology.
authors.affiliation: *Department of Ophthalmology and Vision Sciences, Toronto Western Hospital ‡Dalla Lana School of Public Health, University of Toronto, Toronto †Department of Ophthalmology, Queen's University, Kingston, ON, Canada.
authors.forename: Lilach D
authors.initials: LD
authors.lastname: Wagschal
authors.forename: Graham E
authors.initials: GE
authors.lastname: Trope
authors.forename: Delan
authors.initials: D
authors.lastname: Jinapriya
authors.forename: Ya-Ping
authors.initials: YP
authors.lastname: Jin
authors.forename: Yvonne M
authors.initials: YM
authors.lastname: Buys
mesh_terms: D000368:Aged; D000477:Alkylating Agents / Q000008:administration & dosage; D003228:Conjunctiva / Q000187:drug effects; D005260:Female; D020327:Glaucoma Drainage Implants; D005902:Glaucoma, Open-Angle / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods; D014065:Tonometry, Ocular; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000477:Alkylating Agents; D016685:Mitomycin