What are the express shunt data for trabeculectomy (surgical procedure for glaucoma)?

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Last updated: March 1, 2025 • View editorial policy

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From the Guidelines

Trabeculectomy is effective in lowering intraocular pressure (IOP) with a success rate ranging from 31% to 88% in different populations, and it is generally indicated when medications and appropriate laser therapy are insufficient to control disease. When considering express shunt data for trabeculectomy, it is essential to document and analyze outcomes from glaucoma drainage devices (shunts) compared to trabeculectomy procedures. The key factors to consider include:

  • Pre-operative IOP
  • Post-operative IOP at various time points (1 day, 1 week, 1 month, 3 months, 6 months, and annually)
  • Medication requirements before and after surgery
  • Complications (hypotony, choroidal effusion, endophthalmitis, tube erosion, bleb leaks)
  • The need for additional procedures According to the most recent study 1, trabeculectomy lowered IOP by 58% compared to medical therapy, which reduced IOP by 42%. Additionally, the study found that trabeculectomy had a lower rate of visual field deterioration compared to medical therapy. The use of antifibrotic agents, such as mitomycin C, can improve the success rate of trabeculectomy by reducing subconjunctival scarring 1. Overall, the decision to perform trabeculectomy or use a glaucoma drainage device should be based on individual patient factors, including age, previous surgeries, and target IOP goals. It is crucial to weigh the benefits and risks of each procedure, considering the potential complications and the need for additional procedures. By carefully evaluating these factors and considering the latest evidence, clinicians can make informed decisions to optimize patient outcomes and minimize morbidity, mortality, and impact on quality of life. The most recent study 1 provides the highest quality evidence, and its findings should be prioritized when making clinical decisions. In particular, the study's results on the effectiveness of trabeculectomy in lowering IOP and reducing visual field deterioration should be taken into account when determining the best course of treatment for patients with glaucoma.

From the Research

Express Shunt Data for Trabeculectomy

  • The ExPress shunt is an adjunctive device used in trabeculectomy to create an external fistulization, with the goal of lowering intraocular pressure (IOP) in glaucoma patients 2.
  • Studies have compared the outcomes of trabeculectomy with ExPress shunt to other surgical procedures, such as Baerveldt 101-350 glaucoma implant (BGI) and trabeculectomy with Ologen implant 2, 3.
  • The survival rate at 12 months was 85% in the BGI group and 80% in the trabeculectomy with ExPress Shunt group, with no statistically significant difference in the survival distributions between surgery groups 2.
  • The mean IOP was reduced from 20.6 ± 5.6 mmHg to 12.4 ± 3.2 mmHg and from 20.7 ± 5.5 mmHg to 11.3 ± 4.8 mmHg at one year post-operation in the BGI group and the trabeculectomy with ExPress shunt group, respectively 2.
  • Trabeculectomy with ExPress shunt had a higher success rate and lower complication rates compared to trabeculectomy with Ologen implant 3.
  • The ExPress shunt group showed significantly less choroidal detachment due to low IOP, and earlier laser suture lysis was required to obtain outcomes comparable to those of conventional trabeculectomy 4.
  • In pediatric glaucoma patients, EX-PRESS shunt with mitomycin-C (MMC) appeared to have better IOP control, better visual acuities, and fewer complications and reoperations compared to trabeculectomy with MMC 5.

Comparison of Express Shunt to Other Surgical Procedures

  • Trabeculectomy with MMC had a higher surgical success rate than tube shunt implantation after 1 year, with lower IOP and fewer glaucoma medications 6.
  • The frequency of serious complications producing vision loss or requiring reoperation was lower after tube shunt surgery relative to trabeculectomy with MMC 6.
  • EX-PRESS shunt with MMC had better IOP control and visual acuities compared to trabeculectomy with MMC in pediatric glaucoma patients 5.

Postoperative Outcomes

  • The average decrease in medications postoperatively was 0.375 and 1.63 for trabeculectomy and EX-PRESS shunt, respectively 5.
  • Preoperative visual acuities compared to postoperative best-corrected visual acuities demonstrated a slight average worsening of 0.11 logMAR in trabeculectomy patients and an average improvement of 0.56 logMAR in EX-PRESS shunt patients 5.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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