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J.A. Evangelista, D.L. Johnson, R. Trespalacios, J. Frankel; Ex–PRESSTM Shunt Under a Scleral Flap for Neovascular Glaucoma . Invest. Ophthalmol. Vis. Sci. 2006;47(13):24.
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© ARVO (1962-2015); The Authors (2016-present)
To review outcomes of the Ex–PRESSTM (Optonol Ltd, Kansas City, KS) glaucoma mini shunt under a partial–thickness scleral flap as treatment for raised intraocular pressure (IOP) in neovascular glaucoma.
A retrospective case series of 4 eyes of 4 male patients with neovascular glaucoma and a mean age of 64 years (range: 48 to 74) who were treated with an Ex–PRESS shunt under a 4 millimeter scleral flap was done. All eyes had retinal ablation performed pre–operatively yet inadequately controlled IOP with topical and systemic medications persisted. Outcome measures were IOP, number of IOP lowering medications, and best corrected visual acuity (BCVA).
A significant (p<0.05) decrease in IOP and IOP lowering medications along with an increase in BCVA was observed in the post–operative period (mean: 105 days; range: 76 to 169 days) (see table for complete data). Patient # 3 required one topical IOP lowering drop in the final post–operative period while the other patients did not require any medical therapy for IOP control. Patient # 4, who refused more definitive therapy for a painful, no light perception eye, had a suprachoroidal hemorrhage without hypotony in the early postoperative period with spontaneous resolution at 45 days post–operatively; there were no other post–operative complications.
An Ex–PRESS shunt under a scleral flap is a viable therapy for increased IOP associated with neovascular glaucoma. While an increase in BCVA and a decrease in IOP and IOP medication use were found, complications related to rapid reduction of IOP can occur.
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