ExPRESS Shunt Implantation With Scleral Flap Technique for Complicated Glaucoma

Abstract

Abstract: : 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.

Keywords: clinical (human) or epidemiologic studies: systems/equipment/techniques • clinical (human) or epidemiologic studies: outcomes/complications • wound healing