May 2008
Volume 49, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2008
Long-Term Results of the Ex-PRESS Miniature Glaucoma Implant Under a Scleral Flap
Author Affiliations & Notes
  • A. Prasad
    Glaucoma, Wills Eye Institute, Philadelphia, Pennsylvania
  • D. J. Freitas
    Glaucoma, Wills Eye Institute, Philadelphia, Pennsylvania
  • J. K. Navarro
    Glaucoma, Wills Eye Institute, Philadelphia, Pennsylvania
  • D. Lankaranian
    Glaucoma, Wills Eye Institute, Philadelphia, Pennsylvania
  • M. R. Moster
    Glaucoma, Wills Eye Institute, Philadelphia, Pennsylvania
  • Footnotes
    Commercial Relationships  A. Prasad, None; D.J. Freitas, None; J.K. Navarro, None; D. Lankaranian, None; M.R. Moster, Optonol Ltd., R.
  • Footnotes
    Support  None.
Investigative Ophthalmology & Visual Science May 2008, Vol.49, 4179. doi:https://doi.org/
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    • Get Citation

      A. Prasad, D. J. Freitas, J. K. Navarro, D. Lankaranian, M. R. Moster; Long-Term Results of the Ex-PRESS Miniature Glaucoma Implant Under a Scleral Flap. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4179. doi: https://doi.org/.

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

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Abstract

Purpose: : To evaluate the safety and efficacy of the Ex-PRESS Miniature Glaucoma Shunt under a scleral flap with adjunctive intraoperative mitomycin C (MMC) for uncontrolled glaucoma

Methods: : A retrospective study was done of 148 eyes of 124 patients who underwent placement of an Ex-PRESS Shunt under a partial-thickness scleral flap with MMC between March 2003 and October 2006. Three types of shunts were used, all with a 50-micron lumen: R-50 (n = 118), T-50 (n = 27), and X-50 (n = 3). Main outcome measures included success rate, visual acuity (VA) change, number of antiglaucoma medications, intraocular pressure (IOP), and postoperative complications. Intraoperative MMC ( 0.4 mg/ml) was used for all patients. Overall success was defined as IOP > 5 mm Hg and ≤ 21 mm Hg with or without need for antiglaucoma medications and without need for further surgery. Complete success was defined as IOP within the range specified above without need for glaucoma medications.

Results: : We studied 148 eyes of 124 patients: 42 (28.4% ) males and 106 (71.6%) females, mean age of 77.6 ± 11.4 years. The follow-up period was up to 4 years (mean 22.46 months ± 9.96). Mean time of MMC application was 1.5 ± 0.3 minutes. The number of medications was reduced from 2.86 ± 1.14 (preoperative) to 0.62 ± 1.02 (last visit) (p < 0.0001). Mean IOP was reduced from 28.57 ± 10.71 (preoperative) to 14.54 ± 6.46 (postoperative) (p < 0.0001). There was no significant difference between mean logMAR preoperative VA 0.76 ± 0.73 and logMAR last visit VA 0.84 ± 0.83 (p = 0.155). Complete success rate (without medications) was 57.43% (n = 85) and overall success rate (with or without medications) 78.85% (n = 117). Complications included high IOP (n = 17), hypotony (n = 9), and conjunctival leak (n = 3).

Conclusions: : The Ex-PRESS Shunt under a scleral flap with adjunctive MMC provides a safe and effective alternative to traditional glaucoma surgery. The significant reduction in IOP obtained was longstanding with few complications.

Keywords: intraocular pressure • anterior chamber • sclera 
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