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Sara Ferri, Ramanath Bhandari, Jeffrey Freedman; Long Term Comparison, Including Patterns of Failure, of a Single Surgeon Subscleral Implantation of Ex-PRESS Miniature Glaucoma Shunts Between African American and Caucasian Glaucoma Patients. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2634.
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To compare the clinical outcomes, including patterns of failure, of the Ex-PRESS miniature glaucoma shunt between African American and Caucasian patients with open angle glaucoma.
In this retrospective analysis, we compared 64 eyes of 55 African American patients and 44 eyes of 35 Caucasian patients with open angle glaucoma implanted with a subscleral Ex-PRESS miniature glaucoma shunt with Mitomycin C by a single surgeon.
Mean age was 71 and 76 for African American and Caucasian patients respectively. Mean length of follow up was 23.3 months (12-76) for African American patients and 23.5 months (12-66) for Caucasian patients. Success was defined as an IOP less than or equal to 18mm Hg with or without additional glaucoma medications. Mean pre-operative IOP was 27mmHg and 30mmHg in African American and Caucasian eyes respectively. Mean post operative IOP was 13mmHg and 12mmHg in African American and Caucasian eyes respectively. Pressure reduction in both groups was significant by the Wilcoxon signed-rank test (p < 0.05). Mean length of time of failure was 12 months in African American patients and 24.5 months in Caucasian patients (p < 0.05; unpaired t-test). 14 of the 24 African American eyes failed within 1 year with 10 of the eyes failing within 6 months. Only 2 of the 15 Caucasian eyes failed within one year. Using the Kaplan-Meier survival analysis, the rate of failure within the first year, was 22% for African American patients and 5% for Caucasian patients. The Log-Rank Mantel-Haensel Test for Comparison of Survival Curves at one year indicated a significant difference between the two groups (p < 0.05).
This is the first study to specifically report on long term results, as well as patterns of failure, between African American and Caucasian glaucoma patients treated with subscleral implantation of Ex-PRESS miniature glaucoma shunts by a single surgeon. We found a definite pattern of failure between African American and Caucasian patients, suggesting that not only do African Americans have a higher rate of failure but also tend to fail much earlier than Caucasian patients. Based on these findings, a prospective study looking at methods to decrease earlier failure in African American patients may be useful with this device.
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