Abstract
Objective
To compare reoperation rates between Ex-PRESS implantation and trabeculectomy.
Methods
We performed a retrospective cohort study using a national inpatient database in Japan. Patients aged 18–85 years with primary open-angle glaucoma or normal-tension glaucoma who underwent Ex-PRESS or trabeculectomy from 2010 to 2017 were included. We compared the reoperation rates between Ex-PRESS and trabeculectomy using mixed effects cox regression models. Covariates were sex, age, diabetes mellitus, simultaneous cataract surgery, ocular surgical history, and annual hospital volume for glaucoma surgery. Furthermore, we conducted propensity score (PS) matching and instrumental variable (IV) analyses to confirm the results of the conventional cox regression. We also compared total hospitalisation costs between the two treatments in the PS-matched groups.
Results
In total, 1027 eyes underwent Ex-PRESS and 6910 eyes underwent trabeculectomy. The reoperation rates were 7.6% and 5.8% in the Ex-PRESS and trabeculectomy groups, respectively. The most frequently performed type of reoperation was trabeculectomy in both groups. The mixed effects cox regression showed that Ex-PRESS had significantly higher reoperation rates than trabeculectomy [adjusted hazard ratio (aHR), 1.72; 95% confidence interval (CI), 1.31–2.25; p < 0.001]. The PS and IV analyses also showed similar results (for PS analysis: aHR, 2.13; 95% CI, 1.45–3.13; p < 0.001; for IV analysis: aHR, 2.26; 95% CI, 1.05–4.85; p = 0.037). The total hospitalisation cost of Ex-PRESS (US$7076) was significantly greater than that of trabeculectomy (US$6223) (p < 0.001).
Conclusion
Ex-PRESS implantation had significantly higher reoperation rates and greater cost than trabeculectomy.
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Funding
This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (H30-Policy-Designated-004 and H29-ICT-General-004) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141).
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Hashimoto, Y., Michihata, N., Matsui, H. et al. Reoperation rates after Ex-PRESS versus trabeculectomy for primary open-angle or normal-tension glaucoma: a national database study in Japan. Eye 34, 1069–1076 (2020). https://doi.org/10.1038/s41433-019-0641-6
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DOI: https://doi.org/10.1038/s41433-019-0641-6
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