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Michael Holmboe, Malik Y Kahook, Robert Shields, Leonard Seibold; Efficacy of the EX-PRESS glaucoma drainage device in the treatment of glaucoma. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5016. doi: https://doi.org/.
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To study the two-year outcomes of the EX-PRESS glaucoma drainage device in glaucoma patients and identify risk factors for failure.
Retrospective review of consecutive eyes that underwent implantation of an EX-PRESS glaucoma drainage device under a scleral flap between 2009 and 2013. All procedures were performed by a single surgeon using a standard technique with a limbal-based conjunctival flap and intraoperative mitomycin C application. Complete success was defined as an intraocular pressure (IOP) ≥5 and ≤21 mmHg without the use of glaucoma medication. Qualified success was defined by the same IOP range with or without concomitant glaucoma medication. Failure was defined as IOP <5 or >21 mmHg, loss of light perception vision, or reoperation for glaucoma. Diabetes, ethnicity, number of preoperative medications, and previous eye surgeries were examined as risk factors for failure.
A total of 118 glaucomatous eyes from 98 patients were analyzed. Mean follow-up period was 359.8 ± 316.3 days. Mean IOP was reduced from 22.1 mmHg preoperatively to 14.3 and 14.5 mmHg at 1 and 2 years of follow-up, respectively. Mean medication use dropped from 2.4 preoperatively to 1.0 at 2 years postoperatively. Complete success rates were 80% at 6 months, 68% at 1 year, and 42% at 2 years of follow up. Qualified success rates were 82%, 72%, and 69% at the same time intervals respectively. Cox proportional hazard ratios failed to show a significant predictor of success (Diabetes 1.64, caucasian 0.78, number of preoperative medications 1.3, prior surgery 1.1; p>0.05 for all).
Implantation of the EX-PRESS glaucoma drainage device is an effective surgical method for reducing intraocular pressure in uncontrolled glaucoma.
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