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R. Reis, D. Lankaranian, J.C. Ramos–Esteban, M.R. Moster, J.F. Lopes; Intermediate–Term Results of Ex–PRESS TM Miniature Glaucoma Implant Under Scleral Flap . Invest. Ophthalmol. Vis. Sci. 2006;47(13):50.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the efficacy of Ex–PressTM Miniature Glaucoma Implant under scleral flap with adjunctive intra–operative mitomycin–C (MMC) in the management of complicated glaucoma
The medical records of 35 advanced glaucoma patients who underwent Ex–PRESSTM tube shunt surgery under a scleral flap between March 2003 and November 2004 were reviewed. The patients were followed at day 1, week 2, months 1, 3, 6, and 12 following surgery. Main outcome measures included success rate and change in visual acuity (VA), number of antiglaucoma medications, intra–ocular pressure (IOP), and post–operative complications. Intra–operative MMC 0.4 mg/ml was used for all patients. Success was defined as IOP > 5 mmHg and ≤ 21 mmHg with or without anti–glaucoma medications and without need for further surgery. Student's paired t test was used for pre– and post–operative comparisons. A p value < 0.05 was considered significant.
Thirty–five consecutive patients (35 eyes), 9 (25.7%) males and 26 (74.3%) females, with a mean age of 75.3 ± 10.4 years (range 48.6 – 95.0) were included. Mean follow–up time was 14.3 ± 3.3 months. The major types of glaucoma were primary open– angle glaucoma (54.3%) followed by pseudoexfoliation syndrome (17.1%), and angle–closure glaucoma (17.1%). Thirty–three (94.3%) eyes had previous incisional surgery, and 19 (54.3%) had previous failed trabeculectomy. Mean time of MMC application was 1.48 minutes (range 1 – 2.50). There was no significant difference between mean logMAR preoperative VA (0.74 ± 0.77) and logMAR last visit VA (0.83 ± 0.90) (p=0.26). The mean number of antiglaucoma medication was decreased from 2.78 ± 1.05 (pre–operative) to 0.31 ± 0.66 (last visit) (p<0.0001). Mean IOP was decreased from 32.2 ± 10.4 mmHg (pre–operative) to 13.9 ± 5.1 mmHg (post–operative) (p<0.0001). The success rate was 85.7% (30 eyes) from which 5 were controlled with ≤ 2 medications. Surgery failed in 5 cases (14.3%) from which 3 eyes eventually underwent Ahmed valve implant, 1 eye developed sustained hypotony, and in 1 eye, the IOP remained > 21mmHg despite suture lysis and medical thearpy.
Ex–PRESSTM Miniature Glaucoma Implant under scleral flap augmented with intraoperative MMC has been shown to be effective in reducing IOP in complicated glaucoma.
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