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Resident-performed Ex-PRESS Shunt Implantation Versus Trabeculectomy

Seider, Michael I. MD; Rofagha, Soraya MD, MPH; Lin, Shan C. MD; Stamper, Robert L. MD

doi: 10.1097/IJG.0b013e3182182bfb
Original Studies

Purpose To compare outcomes between resident-performed trabeculectomy and Ex-PRESS shunt implantation.

Methods A consecutive cohort of 36 Ex-PRESS shunt implantations and 57 trabeculectomies (1 eye/patient) performed by resident surgeons in their third year of ophthalmic training at the University of California, San Francisco and at the San Francisco Veterans Administration Hospital, under the supervision of a single glaucoma fellowship-trained surgeon were included in this study. Eyes with < 6 months of follow-up or previous glaucoma surgery were excluded. Preoperative and postoperative intraocular pressure (IOP), preoperative and postoperative number of ocular antihypertensive medications and complication rates were compared between the 2 procedures retrospectively.

Results No difference was found in postoperative IOP (all, P≥0.099) or proportional decrease in IOP (all, P≥0.092) between the trabeculectomy and Ex-PRESS shunt groups at all follow-up points. On average, the Ex-PRESS shunt group required significantly less ocular antihypertensive medication to control IOP at 3 months postoperative (P=0.01), but no difference was found at 6 months or 1 year (all, P≥0.28). A larger proportion of Ex-PRESS shunt patients had good IOP control without medication at 3 (P=0.057) and 6 months (P=0.076) postoperatively. No difference was found in the rates of sight-threatening complications between groups (all, P≥0.22).

Conclusions In the hands of ophthalmology residents in their third year of training, the trabeculectomy and Ex-PRESS shunt implantation procedures perform comparably in terms of postoperative IOP control, reduction in patient dependence on ocular antihypertensive medications, and risk of complication in our population.

Department of Ophthalmology, University of California, San Francisco, CA

Supported by Research to Prevent Blindness, NIH-NEI EY002162–Core Grant for Vision Research, and That Man May See, Inc. Robert Stamper has received travel funds from Optonol Ltd. in the last year. All other authors have no financial disclosure. This study was not sponsored by Optonol Ltd.

Disclosure: Robert L. Stamper, the Principal Investigator, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis and the decision to submit for publication.

Reprints: Michael I. Seider, MD, Koret Building, Box 0730, 10 Kirkham Street, San Francisco, CA 94143-0730 (e-mail:

Received August 8, 2010

Accepted February 28, 2011

© 2012 Lippincott Williams & Wilkins, Inc.