The comparison of efficiency and safety profile of anti-glaucoma surgeries: Trabeculectomy vs. Ex-PRESS implant – a retrospective analysis

Introduction
Among published papers on efficient combined treatment of glaucoma and cataract there are limited conclusions indicating the unambiguous advantages of one particular, currently available method. The classic approach of phacotrabeculectomy has many alternatives including Ex-PRESS implantation performed simultaneously with phacoemulsification. These procedures can also be performed on pseudophakic eyes. The aim of this study was to determine any possible advantages and disadvantages of each method and to compare them.

Material and methods
Records of 105 eyes of 77 patients, who had undergone either trabeculectomy or Ex-PRESS P-200 implantation between the years 2017 and 2022, have been retrospectively reviewed and evaluated for outcomes and complications.

Results
The study of 105 eyes showed no statistically significant differences between the groups regarding the need for additional medical procedures after the treatment. Significant differences were observed in postoperative BCVA (best corrected visual acuity) scores for the phacoEx-PRESS and phacotrabeculectomy groups compared to the trabeculectomy in pseudophakic eyes and Ex-PRESS in pseudophakic eyes groups. Intraocular pressure measurements showed a significant improvement in their values for all groups. When comparing the different groups, a significant difference was discovered between the Ex-PRESS in the pseudophakic eyes group and the trabeculectomy in pseudophakic eyes and phacotrabeculectomy groups. Complications of the procedures occurred in each group; however, the trabeculectomy in pseudophakic eyes and phacoEx-PRESS groups differed significantly.

Conclusions
The efficiency and safety of Ex-PRESS surgery and trabeculectomy, either on pseudophakic eyes or combined with phacoemulsification is similar and every approach provides acceptable results.