Changes in anterior segment parameters following insertion of ExPRESS mini glaucoma implant vs. trabeculectomy

ABSTRACT Purpose: To compare changes in anterior segment parameters following ExPRESS Mini Glaucoma Shunt surgery vs. trabeculectomy using the Pentacam rotating Scheimpflug camera. Methods: In this prospective, comparative study, 27 patients with glaucoma treated at the Rabin Medical Center from 2009 to 2013 were enrolled in this prospective comparative study: 19 participants (19 eyes) underwent ExPRESS shunt implantation and 12 (13 eyes) underwent trabeculectomy. Changes in anterior chamber parameters at postoperative day 1 and postoperative month 3 were evaluated on Scheimpflug images. Results: Intraocular pressure decreased significantly from baseline in both groups. The decrease in both groups was similar at postoperative month 3 (p=0.82). ExPRESS surgery caused a transient increase in posterior corneal astigmatism (p=0.008) and a transient decrease in anterior chamber depth (p=0.016) and volume (p=0.006) on postoperative day 1. At postoperative month 3, these parameters were no longer statistically significant (p=0.65, p=0.51, and p=0.57 respectively). Trabeculectomy caused a transient increase in anterior and posterior corneal astigmatism on postoperative day 1 (p=0.003 and p=0.005, respectively), which were not evident at postoperative month 3 (p=1.0 and p=1.0, respectively). At postoperative month 3, both ExPRESS and trabeculectomy showed similar changes in anterior chamber parameters. Conclusions: Both ExPRESS mini glaucoma implant and trabeculectomy significantly decreased intraocular pressure and had transient effects on anterior segment parameters, with minor differences between the methods.

摘要
目的：采用Pentacam旋转Scheimpflug相机，对比ExPRESS微型青光眼引流器（ExPRESS Mini Glaucoma Shunt）手术与小梁切除术（trabeculectomy）术后眼前节参数的变化。
方法：本研究为前瞻性对照研究，纳入2009年至2013年于拉宾医疗中心接受治疗的27例青光眼患者，其中19例患者（19只眼）接受ExPRESS引流器植入术，12例患者（13只眼）接受小梁切除术。分别于术后第1天及术后3个月，通过Scheimpflug成像评估眼前节参数的变化情况。
结果：两组患者的眼压均较基线水平出现显著下降。术后3个月时，两组的眼压降幅相当（p=0.82）。术后第1天，ExPRESS手术可导致角膜后散光一过性升高（p=0.008），前房深度（p=0.016）及前房容积（p=0.006）一过性降低；至术后3个月时，上述参数差异均无统计学意义（分别为p=0.65、p=0.51及p=0.57）。小梁切除术可于术后第1天引发角膜前、后散光一过性升高（分别为p=0.003及p=0.005），该变化于术后3个月时不再具有统计学意义（分别为p=1.0及p=1.0）。术后3个月时，ExPRESS手术与小梁切除术在眼前节参数变化方面无明显差异。
结论：ExPRESS微型青光眼植入物与小梁切除术均能显著降低眼压，且均会对眼前节参数产生一过性影响，两种手术方式的差异较小。