The authors describe a prospective randomised study of 64 POAG subjects with controlled IOPs comparing visual acuity data in patients randomised to either Ex-Press model P50 or trabeculectomy. Visual acuities were recorded at baseline, day one, weeks one and two and month one, three and six postoperatively. Postoperative complications were recorded plus cup disc ratio and mean deviation on Humphrey Visual Fields. Vision loss was categorised as mild, moderate or severe. The results regarding IOP, central corneal thickness (CCT) and endothelial cell count were not included in this paper. All subjects completed three months follow-up and 61 completed six months. In both groups visual acuity was significantly reduced following surgery, however, the authors found no difference in mean visual outcomes between the two surgical groups. They did, however, find a faster visual recovery with the Ex-Press group compared with trabeculectomy. Their results are similar to other studies such as tube vs. trab as when the visual acuity was evaluated as a categorical variable rather than a continuous variable, those in the trab group lost >2 snellens lines at six months. No difference was found in complication rates. The limitations of the study are reported by the authors as they did not compare IOP between procedures and also visual acuity was measured un-refracted with a pinhole. Further investigation is also required to explore the aetiology further. 

Comparison of visual recovery following Ex-press versus trabeculectomy: results of a prospective randomized controlled trial.
Beltran-Agullo L, Trope GE, Jin YP, et al.
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Lorraine North

Frimley Park Hospital, Frimley, UK.

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