Efficacy and safety of EX-PRESS implanation versus trabeculectomy for open-angle glaucoma: a meta-analysis.
JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2017, 31(2):
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Objective To evaluate the efficacy and safety of EX-PRESS implantation(EX-PRESS)compared with trabeculectomy(Trab)in open-angle glaucoma(OAG). Methods Databases including PubMed, EMbase, CNKI, VIP and WanFang Data were electronically searched for all randomized controlled trials(RCTs)about comparing the efficacy and safety between EX-PRESS implantation and trabeculectomy in open-angle glaucoma before the date of March 31, 2016. Two reviewers independently screened literature according to the inclusion and exclusion criteria, and evaluated the included studies. Then, meta-analysis was performed using RevMan5.3 software. Results A total 7 RCTs involving 447 patients with 462 eyes were included, 234 eyes in the EX-PRESS group and 228 eyes in the Trab group. The results of meta-analysis showed that there was significant difference between EX-PRESS and Trab in the postoperative 6 months and 1 year IOPR% ［WMD=-7.67, 95%CI(-14.85, -0.50), P=0.04］ and ［WMD=11.38, 95%CI(1.55, 21.22, P=0.02］, there was no significant difference between EX-PRESS and Trab in 24 months and end of follow-up after surgery IOPR%. The pooled OR was ［OR=2.29, 95%CI(1.27, 4.13), P=0.006］ comparing EX-PRESS with Trab for the complete success rate at one year after surgery and there was no significant difference between Ex-PRESS and Trab in the qualified success rate at one year after surgery ［OR=1.59, 95%CI(0.73, 3.44), P= 山东大学耳鼻喉眼学报31卷2期 -王越,等.EX-PRESS引流器植入术与小梁切除术治疗开角型青光眼有效性和安全性的Meta分析 \=-0.24］ and the number of anti-glaucoma medication ［WMD=-0.10, 95%CI(-0.36, 0.17), P=0.48］. But postoperative 2 year visual acuity ［WMD=-0.12, 95%CI(-0.23,-0.00), P=0.04］ had difference compared EX-PRESS with Trab. The pooled ORs of shallow or flat anterior chamber, hypotony, encapsulated bleb, wound leak, and choroidal effusion respectively was ［OR=1.43, 95%CI(0.71, 2.87), P=0.32］, ［OR=1.03, 95%CI(0.54, 1.96), P=0.94］, ［OR=0.25, 95%CI(0.05, 1.25), P=0.09］, ［OR=0.96, 95%CI(0.35, 2.64), P=0.94］, and ［OR=0.69, 95%CI(0.28, 1.72, P=0.43］ compared EX-PRESS with Trab. But EX-PRESS compared to Trab, with pooled ORs of hyphema ［OR=0.13, 95% CI(0.04, 0.42), P=0.0006］. Conclusion Trab had a better effect in IOPR% at 6 months after surgery, but EX-PRESS had a better effect in 1 year after surgery. But EX-PRESS surgery complete success rate was higher and EX-PRESS was associated with a significantly lower frequency of the hyphema compared to trabeculectomy. Moreover, Trab got better recovery of visual acuity. And there was no difference in the number of anti-glaucoma medication for the people need medications control the IOP between the two surgeries.