The effectiveness of AGV, Ex-PRESS, or trabeculectomy in the treatment of primary and secondary glaucoma: a systematic review and network meta-analysis

Background: In this study, we compared the efficacy of Ahmed, Ex-PRESS, and trabeculectomy to provide a reference for determining surgical schemes for glaucoma patients undergoing external drainage surgery in clinical practice. Methods: We performed a literature search for studies on the treatment of primary and secondary glaucoma with three types of external drainage surgery (Ahmed, Ex-PRESS, and trabeculectomy). As at April 24, 2021, seven electronic databases were searched for randomized controlled trials comparing any two of Ahmed, Ex-PRESS, and trabeculectomy in the treatment of glaucoma. The Cochrane tool was also adopted to evaluate the risk of bias in these trials. The relative risk (RR) with 95% confidence interval (CI), and weighted mean difference (WMD) were determined and compared indirectly using R software. Results: A total of 14 randomized controlled trials were induded in this study, involving 866 eyes of 808 patients. As for the intraocular pressure (IOP) after 3 months, trabeculectomy did not contribute to better improvement than Ahmed (WMD =0.014; 95% CI: -0.14-0.18) and Ex-PRESS (WMD =0.014; 95% CI: 0.072-0.097). However, there was a significant difference in the IOP 1 year between trabeculectomy and Ex-PRESS (WMD =0.097; 95% CI: 0.0080-0.18), with the latter achieving a favorable improvement effect. Meanwhile, the complete success (CS) of trabeculectomy was significantly lower than that of Ex-PRESS (RR =0.73; 95% CI: 0.57-0.93). In addition, Ex-PRESS was superior to Ahmed (WMD =-0.48; 95% CI: -0.89 to 0.084) in terms of a decreased number of post-operative medications. Discussion: For glaucoma patients who are required to receive external drainage surgery, Ex-PRESS could achieve a significant effect on the IOP 1 year and CS, as well as a marked decrease in the number of postoperative medications used, compared with the other two types of surgery. In terms of the efficacy at least 1 year after surgery, Ex-PRESS should be one of the preferred methods for external drainage.

Automated summary

This study compared the efficacy of Ahmed, Ex-PRESS, and trabeculectomy in glaucoma surgery. The results showed that Ex-PRESS had better outcomes in terms of intraocular pressure and complete success rate after 1 year, as well as a decrease in postoperative medication use, compared to the other two types of surgery.