الفهرس 
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Abstract
Glaucoma is the leading global cause of irreversible blindness. POAG is a progressive ophthalmic disease which causes damage to the optic nerve and nerve fiber layer resulting in visual field and acuity loss. When topical medications or other interventions (such as laser) do not adequately reduce IOP, incisional surgery (trabeculectomy) is considered. Trabeculectomy is the gold standard glaucoma surgery. However, there is always a need for safer alternatives. Ex-PRESS mini-glaucoma shunt was introduced to be one of these alternatives This present study was conducted to evaluate the efficacy and safety of the Ex-PRESS mini glaucoma shunt in POAG in comparison with trabeculectomy. It was a prospective randomized comparative study. It included 36 eyes of 25 patients with POAG who fulfilled the inclusion criteria. Full preoperative detailed ophthalmologic examination was performed including visual acuity measurement, slit lamp biomicroscopy, IOP measurement, gonioscopy, and fundus examination The patients were randomly assigned into two groups • group 1 included 17 eyes who underwent subscleral trabeculectomy.<br• group 2 included 19 eyes who underwent of EX-PRESS P 50 mini shunt. The mean follow up period was 15.24 ± 5.07 months in group I and was 14.00 ± 4.80 in group II. Six visits were arranged for every case at 1st day, 1st week, 1st month, 3rd, 6th month and one year postoperative. In each visit, complete ophthalmic examination, measurement of the visual acuity and measurement of IOP by Goldmann applanation tonometer were done. AC depth and volume were measured at 1st day, 1st week and 1st month. Endothelial cell count (ECC) was measured at 6 and 12 month. Preoperative IOP was slightly higher in trabeculectomy group (27.1 mm Hg) versus that in the Ex_PRESS group (23.1 mm Hg) and this was with maximum medications, however, it was not significant (P=0.55). During the follow up period IOP showed no significant difference between the two groups except at the early postoperative period (1st day and 1st week) where the mean IOP in the trabeculectomy group was significantly lower than Ex_PRESS group (P<0.001) At 12 months postoperatively, degree of IOP reduction was similar between two groups (39% in group 1 and 38.3% in group 2) with no statistical difference between them P=0.9. During the follow up period, 4 cases in the trabeculectomy group (23.5%) and 3 cases in the Ex_PRESS group (15.8%) showed rise of IOP (more than 18 mm Hg) .IOP in these cases was controlled by topical drops and continued till the end of the follow up period except one case in each group The reduction in number of antiglaucoma medications at one year was 82% in group 1 and 89% in group 2 (P=0.55) .Success rates were calculated according to IOP values at 12 month postoperative. There was no statistically significant difference between the two groups in the success or failure rates .Complete success was achieved in 76.5 % in group I and 84.2% in group II. Qualified or partial success was achieved in 17.6% of cases in group I and 10.5%in group II. There was no statistical difference between the 2 groups as regard preoperative visual acuity. In both groups, VA was significantly reduced following surgery. In the Ex-PRESS group, VA significantly decreased compared with baseline at day 1 and week 1 and however, by month 1, VA was no longer significantly different from baseline and remained nonsignificant at subsequent visits. In the trabeculectomy group, VA remained significantly lower than baseline at each study visit from day1 to 3 months .So VA recovery was faster in the Ex_PRESS group, also in the early postoperative period there was more loss of visual acuity in trabeculectomy group than express group Early hypotony was higher in trabeculectomy group (29.4%) than Ex_PRESS group (10.5 %) but not statistically significant (P value=0.15).The hypotony in all cases was transient and improved with conservative treatment except one case in each group who needed intervention. The mean ECD was 2493.2 ± 246.8 cells/mm2 before the surgery in the Ex_PRESS group and 2473.8 ± 259.8 cells/mm2 in the trabeculectomy group (P value = 0.82). This value decreased significantly in both groups at 12 months postoperatively to 2348.1 ± 309.5 in the Ex_PRESS group and 2276.1 ± 342.4 in the trabeculectomy group. ECC loss at one year was less in the Ex_PRESS group 5.7% versus 8% in the trabeculectomy group (P value=0.051)AC depth and AC volume were more stable in the Ex_PRESS group than trabeculectomy group during the early postoperative period .There was more reduction in the trabeculectomy group in the first week and first month post operatively.