March 2012
Volume 53, Issue 14
Free
ARVO Annual Meeting Abstract  |   March 2012
Intermediate to Long-term Follow-up Of The Ex-press Glaucoma Filtration Device
Author Affiliations & Notes
  • Usha S. Rao
    Ophthalmology,
    Univ of California San Francisco, San Francisco, California
  • Michel Rubin
    Ophthalmology,
    Univ of California San Francisco, San Francisco, California
  • Aiyin Chen
    Ophthalmology,
    Univ of California San Francisco, San Francisco, California
  • Ying Han
    Ophthalmology,
    Univ of California San Francisco, San Francisco, California
  • Travis Porco
    Department of Epidemiology and Biostatistics,
    Univ of California San Francisco, San Francisco, California
  • Robert L. Stamper
    Ophthalmology,
    Univ of California San Francisco, San Francisco, California
  • Footnotes
    Commercial Relationships  Usha S. Rao, None; Michel Rubin, None; Aiyin Chen, None; Ying Han, None; Travis Porco, None; Robert L. Stamper, None
  • Footnotes
    Support  NIH Core Grant, Research to Prevent Blindness
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 3734. doi:
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      Usha S. Rao, Michel Rubin, Aiyin Chen, Ying Han, Travis Porco, Robert L. Stamper; Intermediate to Long-term Follow-up Of The Ex-press Glaucoma Filtration Device. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3734.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : Evaluate the intermediate to long-term clinical outcomes of the Ex-PRESS glaucoma filtration device.

Methods: : Retrospective study of 45 consecutive eyes of 34 patients that received an Ex-PRESS glaucoma filtration device at one institution over a 6 year time period with at least 2 years of follow-up. Thirty eyes received the Ex-PRESS alone and 15 combined with phacoemulsification surgery. Outcome variables were intraocular pressure (IOP), number of anti-glaucoma medications, best corrected visual acuity (BCVA), visual field (VF)/ cup-to-disk ratio (CDR) progression, long term complications, and additional glaucoma procedures. Success was denoted by an IOP between 4 and 18mmHg with or without glaucoma medications and without further invasive glaucoma surgery or laser trabeculoplasty at the last follow-up visit.

Results: : The patients were followed for an average of 46.4 ± 14.3 (range 24 to 72) months. Average preoperative IOP was 21.7±6.61 mmHg and average preoperative number of anti-glaucoma medications was 3.58±0.75. The IOP was 12.6±5.5, 12.0±4.95, 11.4±5.4, 11.7±5.37, 11.7±4.8 and 11±4.9mmHg at 1, 2, 3, 4, 5 and 6 years of follow-up respectively. The number of anti-glaucoma medications was 1.02±1.5, 1.14±1.5, 1.24±1.6, 1.23±1.5, 1.59±1.7 and 0.25±0.5 at those same time points respectively. There was no significant change in BCVA during the post-operative time period (p=0.4). CDR and VF rates of progression were estimated to be 0.00306 (p= 0.002) and 0.0345 (p= 0.0004) respectively. Post-operative complications were observed in nine (20%) eyes: hypotony (IOP<6mmHg) (7 eyes; 15.5%), corneal decompensation (2 eyes; 4.4%), choroidal detachment (1 eye; 2.2%), and Ex-PRESS shunt dislocation (1 eye; 2.2%). Out of all the complications, only corneal decompensation had a significant negative long-term effect on BCVA. Twenty-one (46.6%) eyes required further interventions after the initial glaucoma surgery: argon laser suture lysis (14 eyes; 31.1%), YAG laser to shunt tip (5 eyes; 11.1%), compression suture (1 eye; 2.2%), bleb needling (9 eyes; 20%), replacement of an Ex-PRESS shunt (1 eye; 2.2%) and other glaucoma surgery (2 eyes; 4.4%). The overall success rate was 82.2% at the last follow-up visit.

Conclusions: : The Ex-PRESS glaucoma filtration device is clinically safe and effective, maintaining a long term reduction in IOP and number of anti-glaucoma medications, with minimal progression in visual field and cup-to-disk ratio.

Keywords: clinical (human) or epidemiologic studies: outcomes/complications 
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