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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.
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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
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.
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).
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.
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