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Shalin Shah, Ngo Yen, Thompson Hilary, Jayne Weiss; Perception of Cornea and Glaucoma Subspecialists Regarding Prevalence of Corneal Decompensation with Ex-Press Shunt Placement. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1665.
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Corneal decompensation is a recognized complication associated with anterior chamber insertion of Ahmed, Baerveldt and Molteno (ABM) shunts. By comparison, there are no publications addressing corneal decompensation after Ex-Press shunt placement. The purpose of this study was to assess the prevalence and onset of corneal decompensation with ABM shunts and Ex-Press shunts as perceived by cornea and glaucoma specialists.
A survey was distributed to members of the Cornea Society and Glaucoma Society with questions about frequency and onset of complications after anterior chamber placement of ABM and Ex-Press shunts. The individual was requested to rank the following side effects in order of perceived prevalence: chronic hypotony, corneal decompensation, endophthalmitis, infection, malignant glaucoma, pthisis bulbi, and retinal detachment. Time of onset to corneal decompensation in Ex-Press shunts was compared to that of the ABM group.
17 glaucoma subspecialists and 22 cornea subspecialists participated. Corneal decompensation was listed as the most prevalent of the seven possible complications by both subgroups (chi square < .001). 65.0% of cornea subspecialists and 84.6% of glaucoma subspecialists reported the risk of corneal decompensation to be higher with uncomplicated ABM placement than with Ex-Press shunts (chi square <0.001). The two subgroups also agreed the onset to decompensation was less than two years in the ABM group (57.1% cornea participants, 68.4% glaucoma participants) compared to greater than 2 years in the Ex-Press shunt group (72.7 % cornea respondents, 85.7% glaucoma respondents) (chi square <0.001). 53.8% of cornea respondents and 58.3% of glaucoma respondents reported onset in the Ex-Press shunt group was greater than 5 years.
The results of the survey show a statistically significant agreement among both glaucoma and cornea subspecialists that corneal decompensation is the most prevalent complication of those queried. They also agree decompensation is more prevalent and has a shortened onset in ABM shunts than in Ex-Press shunts. Although there is little literature on corneal decompensation associated with Ex-Press shunts, this initial survey suggests the complication may occur less frequently and is delayed with Ex-Press shunts, thus warranting further investigation.
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