Higher costs, rates of reoperation with Ex-PRESS implants vs trabeculectomy

The implantation of Ex-PRESS, a widely used external mini-shunt, costs more than a trabeculectomy and comes with a higher risk of reoperation, a recent study has found.

The researchers performed a retrospective cohort study including adult patients with primary open-angle glaucoma or normal-tension glaucoma. A total of 1,027 eyes received Ex-PRESS, while 6,910 eyes underwent trabeculectomy. Outcomes were reoperation rates and hospital costs, compared in a propensity score (PS)-matched cohort.

Ex-PRESS eyes were followed for a mean duration of 1.7 years, while trabeculectomy eyes were followed for 2.0 years. PS matching closely balanced the characteristics between groups.

Trabeculectomy was the most frequent reoperation procedure in both the Ex-PRESS (6.2 percent) and trabeculectomy (5.2 percent) groups. There were no cases of tube shunting, cyclophotocoagulation, or cyclocryotherapy for glaucoma reoperation.

Kaplan-Meier analysis found a significant excess in the 4-year incidence proportion of reoperation in the Ex-PRESS group (13.2 percent vs 9.8 percent; p<0.001).

This was confirmed in mixed-effects Cox regression analysis, which showed higher rates of reoperation in the Ex-PRESS eyes (adjusted hazard ratio [HR], 1.72, 95 percent confidence interval [CI], 1.31–2.25; p=0.001), which remained true even after PS matching (adjusted HR, 2.13, 95 percent, 1.45–3.13; p<0.001).

Moreover, the average total hospitalization cost was significantly higher in the Ex-PRESS vs trabeculectomy group after PS matching (USD 7,076 vs 6,223; p<0.001).