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J.F. Lopes, M.R. Moster, S. Wamsley, L. Haim, U. Altangerel, D. Lankaranian, J. Fontanarosa, W.C. Steinmann; ExPRESS Shunt Implantation With Scleral Flap Technique for Complicated Glaucoma . Invest. Ophthalmol. Vis. Sci. 2005;46(13):70.
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Purpose: The original technique of subconjunctival implantation of the ExPress shunt was associated with a high rate of postoperative complications. The implantation of the device under a scleral flap is a technique modification proposed to decrease the risk of postoperative hypotony and conjunctival erosion. This study evaluates the efficacy and safety of implanting the Ex–Press shunt under a scleral flap in patients with complicated glaucoma. Methods: This case series included 21 eyes (21 patients) with uncontrolled complicated glaucoma. All patients were submitted to Ex–Press LR–50 shunt implantation under a scleral flap. Outcome measures included intra–ocular pressure (IOP), visual acuity and complications. Success was defined as intraocular pressure (IOP) ≤ 21mmHg, without medications or further surgery, including needling. Final data is presented for the 6 months follow–up visit. Results: Mean IOP was reduced from baseline 31.8 ± 10.3 mmHg to 6–months 13.1 ± 4.9 mmHg (p<0.001). Sixteen (76.2%) patients were considered successes. Five (23.8%) cases were failures (three were submitted to needling, one to Ahmed tube insertion, and one had IOP of 22). Visual acuity improved or was unchanged in 16 (76.2%) patients, and fell up to two lines in 5 (23.8%) patients. There were no intraoperative complications. Three (14.3%) patients experienced early hypotony, which spontaneously resolved 1 week after surgery. There were no cases of device repositioning/extrusion, conjunctival erosion, hyphema or persistent inflammation. Conclusions: The scleral flap technique for Ex–Press shunt implantation effectively controls IOP in more than 75% of the patients with complicated glaucoma, with no need for medications or additional surgery. This simple procedure modification reduces the risk of postoperative complications associated with the original subconjunctival insertion technique.
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