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E. M. Gianfermi, A. R. Anchala, T. Obertynski, J. Yonker, B. Hughes; Our Experience With R-50 Ex-PRESS Shunt Implantation for Medically Uncontrolled Glaucoma. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4182.
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To investigate the outcome of Ex-PRESS shunt placement under a partial thickness scleral flap for the treatment of medically uncontrolled glaucoma at an urban institution.
A retrospective chart review was performed on patients who underwent R-50 Ex-PRESS shunt implantation for uncontrolled intraocular pressure (IOP). Pre- and post-operative best corrected visual acuities (logMAR), IOP, and number of medications (NOM) were recorded at each patient visit. A paired t-test was used to compare preoperative values to subsequent postoperative values at one, three, six and nine month intervals, with statistical significance defined as p<0.05. The number and types of postoperative complications were recorded; hypotony was defined as an IOP less than 5 mm Hg.
Ex-PRESS shunt implantation was performed on 49 patients. Mean follow-up was 4.3 months. There was a statistically significant decrease in mean IOP from 28.7mmHg to 18.9mmHg (p=0.0035) at the 9 month postoperative period. There was no statistically significant decrease in mean NOM from 2.9 to 1.1 (p=0.29) at the 9 month postoperative period. There was no statistically significant difference in mean best corrected visual acuity preoperatively compared to 9 months postoperatively, with logMAR values of 0.97 and 1.04 respectively (p=0.68). A review of the postoperative complications related to Ex-PRESS shunt placement revealed one case of endophthalmitis, one case of toxic anterior segment syndrome, one case of cystoid macular edema, two cases of hyphema, and two cases of hypotony.
This data demonstrates that Ex-PRESS shunt implantation results in a statistically significant decrease in IOP at the 9 month postoperative period. There was no significant change in number of medications or best corrected visual acuity at the 9 month postoperative period. Ex-PRESS shunt placement appears to be a viable surgical option in the treatment of medically uncontrolled glaucoma, though it has been demonstrated that complications arise.
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