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Swetha Dhanireddy, Ninani C Kombo, C Stephen Foster; Ex-press shunt implantation in Uveitic Glaucoma. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2882.
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To evaluate the outcomes of Ex-press shunt in patients with uveitic glaucoma.
A chart review of all patients with uveitic glaucoma and Ex-press® shunt (Alcon, Fortworth, Texas) implantation between June 2011 and May 2013 at the Massachusetts Eye Research and Surgery Institution was performed. Patients with active uveitis and less than 6 months follow up were excluded from the study. Intraocular pressure (IOP) and anti-glaucoma medications at the examination prior to surgery were compared with those at the 6 month postoperative follow up examination. Surgical success was defined as a 20% or greater decrease in IOP and decrease in anti-glaucoma medications at 6 months follow up.
This study’s population consisted of 10 patients (11 eyes) with a mean age of 66.7 years (range 53-81 years). Three women had previous Ahmed valve implantation, 3 women and 2 men had selective laser trabeculoplasty (SLT), and one woman had trabeculectomy. The types of uveitis seen in the patients were anterior non-granulomatous and granulomatous uveitis, panuveitis, Sarcoid-associated uveitis, Toxoplasmosis posterior uveitis, and Herpetic Keratouveitis. The mean preoperative IOP was 18.7 mmHg (range, 9-34 mmHg) and the mean postoperative IOP was 12.2 mmHg (range, 6-24 mmHg)). The mean number of preoperative anti-glaucoma medications was 3 (range, 1-6 medications) and 1.2 (range, 0-3 medications) 6 months postoperatively. Two eyes failed to have a decrease in IOP by 6 months follow up. One eye had hypotony, defined as IOP 5 or less, at one month follow up. Four eyes (36.4%) achieved surgical success. Seven eyes (63.6%) had a decrease in anti-glaucoma medications and of those, 5 eyes (45.5%) were on no anti-glaucoma medications at 6 months follow up.
Eight eyes (72.7%) had 20% or greater decrease in IOP at 6 months follow up. Therefore, Ex-press shunt implantation is an effective surgical intervention for the management of uveitic glaucoma.
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