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E. M. Kanner, S. R. Sarkisian, Jr., H. Du, P. A. Netland; Comparison of Postoperative Intraocular Pressure Control With Three Models of Ex-PRESS Miniature Glaucoma Device Implanted Under Scleral Flap. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4189. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
The placement of the Ex-PRESS miniature glaucoma implant under a scleral flap has improved successful use of the device. Our purpose was to evaluate postoperative intraocular pressure (IOP) control using the three currently available models of the device (R-50, T-50, and X-50).
This was a retrospective, non-comparative case series. Patients with uncontrolled glaucoma or visually significant cataract and glaucoma requiring multiple medications were treated with the Ex-PRESS implant (Optonol Ltd, Neve Ilan, Israel) under a scleral flap and standard cataract surgery (if needed). At least 3 nylon sutures were used for closure of the scleral flap. Success was defined as intraocular pressure (IOP) between 5 and 21 mmHg with or without additional medicines, and without further glaucoma surgery.
In this series, 313 eyes were treated with the Ex-PRESS implant. Of these, 157 received the R-50 implant, 112 received the T-50 implant, and 44 received the X-50 implant. The mean follow-up period was 24.9 months. During the early postoperative period, IOP reduction was greater with the X-50 and T-50 compared with the R-50 implant. At 1 year after surgery, the mean IOPs (mmHg) were 15.1 ± 7.5 for R-50, 11.8 ± 3.8 for T-50 (P<0.001, compared with R-50), and 11.2 ± 5.5 for X-50 (P=0.002, compared with R-50). The number of glaucoma medications was significantly reduced with all models of Ex-PRESS implant. To control IOP in the postoperative period, the average number of laser suture lysis procedures was 1.63±1.18 for the R-50, 1.09±1.16 for the T-50, and 0.39±0.72 for the X-50 implants These numbers were all statistically different, P<0.001 (T-50 compared to R-50), P<0.001 (X-50 compared to R-50), and P<0.001 (X-50 compared to T-50).
All Ex-PRESS devices implanted under a scleral flap with multiple sutures provides satisfactory IOP control and adjustability. The X-50 and T-50 provided lower post-operative IOP levels at 1 year, and the X-50 required the lowest number post-operative adjustments with laser suture lysis.
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