Comparison of EX-PRESS Shunt and Trabeculectomy With Mitomycin-C in Congenital and Juvenile Glaucoma.
OBJECTIVE
To compare efficacy and safety of EX-PRESS mini glaucoma shunt (Alcon) and trabeculectomy with mitomycin-C (MMC) in the management of pediatric glaucoma.


METHODS
The authors retrospectively reviewed patients from a single pediatric ophthalmology practice with either congenital or juvenile glaucoma who underwent surgical treatment with either trabeculectomy or EX-PRESS shunt insertion with MMC. Postoperative intraocular pressure at 6, 18, and 36 months, medication requirements, visual acuities, postoperative interventions, complications, and noncompliance with medications or follow-up was reviewed.


RESULTS
A total of 42 cases of glaucoma with either trabeculectomy or EX-PRESS shunt were identified for review (n trabeculectomy=25, n EX-PRESS=17). At 6 months, 62.5% of trabeculectomies and 94.1% of EX-PRESS shunts met criteria for success (P=0.0281). At 18 months, 38.1% of trabeculectomies and 81.3% of EX-PRESS shunts met criteria for success (P=0.0178). At 36 months, trabeculectomies had a success rate of 33.3% versus 66.7% for EX-PRESS shunts (P=0.321). The average decrease in medications postoperatively was 0.375 and 1.63 for trabeculectomy and EX-PRESS shunt, respectively (P=0.06). Preoperative visual acuities compared with postoperative best-corrected visual acuities before additional surgery demonstrated a slight average worsening of 0.11 logMAR in trabeculectomy patients and an average improvement of 0.56 logMAR in EX-PRESS shunt patients (P=0.0037).


CONCLUSIONS
In this review, patients with pediatric glaucoma managed with EX-PRESS shunt with MMC compared with trabeculectomy with MMC appear to have better intraocular pressure control, better visual acuities, and fewer complications and reoperations.
*Mayo Clinic, Rochester, MN†Eastern Virginia Medical School, Norfolk, VA.
David L
DL
Nash
Eric R
ER
Crouch
Earl R
ER
Crouch
D000293:Adolescent; D000477:Alkylating Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005901:Glaucoma / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D020327:Glaucoma Drainage Implants; D006801:Humans; D006871:Hydrophthalmos / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007223:Infant; D007231:Infant, Newborn; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage*; D011184:Postoperative Period; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D014065:Tonometry, Ocular; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
D000477:Alkylating Agents; D016685:Mitomycin