In the JournalsPerspective

Glaucoma filtration device, trabeculectomy similarly successful at 2 years

A glaucoma filtration device and trabeculectomy yielded similar clinical and visual results at 2 years, according to a study.

The prospective randomized multicenter trial included 120 eyes of 120 patients; 59 eyes were treated with the Ex-Press device (Alcon) and 61 eyes underwent trabeculectomy.

Patients in both groups were followed for 2 years after surgery. Surgical success was defined as IOP of 5 mm Hg to 18 mm Hg with or without medications and without additional glaucoma surgery.

Baseline logMAR visual acuity was 0.3 in the Ex-Press group and 0.25 in the trabeculectomy group. Postoperative visual acuity was 0.28 in the Ex-Press group and 0.37 in the trabeculectomy group at 2 years.

Mean visual acuity decreased significantly in both groups at 1 day but recovered at 1 month in the Ex-Press group and 3 months in the trabeculectomy group.

Mean IOP decreased from 25.1 mm Hg at baseline to 14.7 mm Hg in the Ex-Press group and from 26.4 mm Hg to 14.6 mm Hg in the trabeculectomy group. The decrease in IOP was statistically significant in both groups (P < .001).
Medication use decreased significantly in both groups at 2 years (P < .001).

The 2-year success rate was 83% in the Ex-Press group and 79% in the trabeculectomy group.

Disclosure: See the study for a full list of all authors’ relevant financial disclosures.

A glaucoma filtration device and trabeculectomy yielded similar clinical and visual results at 2 years, according to a study.

The prospective randomized multicenter trial included 120 eyes of 120 patients; 59 eyes were treated with the Ex-Press device (Alcon) and 61 eyes underwent trabeculectomy.

Patients in both groups were followed for 2 years after surgery. Surgical success was defined as IOP of 5 mm Hg to 18 mm Hg with or without medications and without additional glaucoma surgery.

Baseline logMAR visual acuity was 0.3 in the Ex-Press group and 0.25 in the trabeculectomy group. Postoperative visual acuity was 0.28 in the Ex-Press group and 0.37 in the trabeculectomy group at 2 years.

Mean visual acuity decreased significantly in both groups at 1 day but recovered at 1 month in the Ex-Press group and 3 months in the trabeculectomy group.

Mean IOP decreased from 25.1 mm Hg at baseline to 14.7 mm Hg in the Ex-Press group and from 26.4 mm Hg to 14.6 mm Hg in the trabeculectomy group. The decrease in IOP was statistically significant in both groups (P < .001).
Medication use decreased significantly in both groups at 2 years (P < .001).

The 2-year success rate was 83% in the Ex-Press group and 79% in the trabeculectomy group.

Disclosure: See the study for a full list of all authors’ relevant financial disclosures.

    Perspective

    The XVT study represents the highest level of evidence as a randomized controlled trial. The success rates were similar between both groups, but some advantages were seen in the early postoperative period with regard to the speed of visual recovery, IOP variation and number of patients who experienced a complication. For the individual patient, the potential advantages and economic costs need to be weighed.

    • Douglas J. Rhee, MD
    • OSN Glaucoma Board Member

    Disclosures: Rhee is a consultant for Aerie, Alcon, Allergan, Aquesys, Ivantis, Johnson and Johnson, and Santen.