Purpose:
To compare the safety and efficacy of two different versions of the Ex–PRESS miniature shunt implanted under a scleral flap in open angle glaucoma patients.
Methods:
Adult patients with uncontrolled open angle glaucoma who needed filtration surgery were enrolled in a prospective non–randomized study. The Ex–PRESS R50 or X200 (50 or 200 microns lumen) versions were implanted under a scleral flap from December 2000 onward. The patients were followed up for postoperative complications and intraocular pressure (IOP) control.
Results:
30 eyes of 27 patients were implanted with either the R50 (15 eyes of 15 patients) or the X200 (15 eyes of 12 patients) version. The average follow up was 72.7±39.2 weeks. Preoperative mean IOP was 31.3mmHg±8.1 (R50) and 31.1mmHg±5.1 (X200). The mean number of preoperative antiglaucoma medications was 1.3±1.3 (R50) and 3.4±0.7 (X200). Day one postoperative IOP was 5.7mmHg±5.3 (R50) and 7.9mmHg±5.1 (X200). Twelve months postoperative IOP was 13.8mmHg±2.1 (R50) and 15.4mmHg±3.8 (X200). 24 months postoperative IOP was 13.4mmHg±3.1 (R50) and 14mmHg±0 (X200). The total success rate (IOP ≤ 18mmHg without antiglaucoma medications) was 80% in the R50 group and 86.7% in the X200 group. Postoperative complications included two cases (13.3%) of device iris touch and two cases (13.3%) of hyphema in the R50 group. Three cases of shallow anterior chamber (20%) on day one occurred in the X200 group.
Conclusions:
Both the R50 and X200 Ex–PRESS mini–shunts are equally effective in reducing IOP, and reducing the number of antiglaucoma medications. The R50 and the X200 versions are both clinically safe however, the R50 version is associated with more device iris touch and the X200 has more incidence of shallow A/Cs on day one.
Keywords: intraocular pressure • anterior chamber • wound healing