Efficacy and economic analysis of Ex- PRESS implantation versus trabeculectomy in uncontrolled glaucoma： a systematic review and Meta-analysis

To systematically review the current evidence based on the efficacy and cost of Ex-PRESS implantation and trabeculectomy (Trab) for uncontrolled glaucoma.Clinical trials were identified by electronic databases (PubMed, EMBASE, ISI Web of science and Cochrane library), and data, such as intraocular pressure (IOP), the complete and qualified success rate, the postoperative complications and the cost, were exacted from these relevant studies. Weighted mean difference (WMD), odds ratio (OR) and 95% confidence intervals (CIs) were calculated and were pooled using a random-effects model.Eleven relevant publications and two abstracts met the inclusion criteria. The efficacy of Ex-PRESS was similar to that of Trab in the percentage of IOP reduction (IOPR %) at 1, 2y (WMD: -2.01; 95% CI: -7.92-3.90; P=0.50 and WMD: 2.89; 95% CI: -8.05-13.83; P=0.60, respectively). Ex-PRESS possessed a significant higher complete and qualified success rate (OR: 1.59; 95% CI: 1.07-2.35; P=0.02 and OR: 1.74; 95% CI: 1.06-2.86; P=0.03, respectively). Moreover, Ex-PRESS exerted a significantly lower frequency of hypotony and hyphema than Trab (OR: 0.39; 95% CI: 0.21-0.72; P=0.003 and OR: 0.27; 95% CI: 0.10-0.69; P=0.003, respectively). However, there was no consistent result on the cost between the two groups according to the previous three studies.Both Trab and Ex-PRESS have equivalent efficacy in lowering IOP, yet Ex-PRESS had a lower risk of hypotony and hyphema than Trab. Nevertheless, whether the cost of Ex-PRESS was less than that of Trab should be further investigated to ensure evidence-based conclusion in the long run.