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George C. Papachristou, Ali Aminlari, Wenxin Wei; Efficacy & Complications Of ExPress Mini Shunt Surgery For Uncontrolled Glaucoma. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2635.
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To evaluate the efficacy and complications of ExPress Mini Shunt for surgical treatment of glaucoma.
Retrospective, chart review of 45 patients undergoing ExPress Mini Shunt glaucoma procedure for treatment of uncontrolled glaucoma, between May, 2009 - October, 2010. All procedures were performed by a single surgeon (AA). The study included patients with glaucoma, undergoing ExPress Mini Shunt surgery alone or combined with cataract extraction. Intraocular pressure (IOP), visual acuity, glaucoma medications, and complications were recorded preoperatively, and postoperatively at 1 day, 1 week, 1 month, 2 months, 4 months, 6 months and 1 year. Similar to the Tube Vs Trabeculectomy (TVT) study shunt failure was defined as; IOP>21mHg, or not reduce by 20% from the baseline on consecutive visits after 3 months, IOP <5 mmHg on consecutive visits, re-operation for glaucoma or loss of light perception.
Forty-five patients and 49 cases were included in the study. Average age at surgery was 69.84(±18.22), with the majority being female (63.27%;n=31) Vs male (36.74%;n=18). The majority of eyes were pseudophakic (57.14%;n=28). Etiology of glaucoma was chronic open angle glaucoma (42.86%;n=21), neovascular (16.33%;n=8), pseudoexfoliation (10.20%;n=5), combined mechanism (10.20%;n=5), inflammatory (4.08%;n=2), congenital (4.08%;n=2), aphakic (4.08%;n=2), low tension glaucoma (2.04%;n=1), post penetrating keratoplasty (2.04%;n=1), steroid induced (2.04%;n=1), pigment dispersion syndrome (2.04%;n=1). Mean IOP at the preoperative visit, post-operative visit day 1, week 1, month 1, month 2, month 4, month 6, and 1 year was 26.78±9.54, 10.54±5.71, 16.59±8.9, 18.67±7.39, 18.85±9.35, 18.29±10.54, 12.82±4.58, 13.89±4.26 respectively. Average glaucoma medication usage at the preoperative visit, post-operative visit day 1, week 1, month 1, month 2, month 4, month 6, and 1 year was 3.84, 0.41±1.15, 0.16±0.52, 0.31±0.87, 0.74±1.24, 1.14±1.42, 1.38±1.89, 1.09±1.51, 0.89±1.17 respectively. The rate of ExPress Mini shunt failure was 18.52%. Postoperative complications developed in 20 (40.82%) patients, with choroidals being most common (n=14;28.57%).
Express Mini shunt insertion achieved a statistically significant reduction in IOP at the 1 year post operative (0.015) visit, while conferring a statistically significant decrease in medication use. The rate of failure was similar to studies evaluating trabeculectomies to other shunts, though the study is limited by a small sample size and short follow up to date.
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