Abstract
Abstract: :
Purpose:To study the efficacy in lowering intraocular pressure and the complication profile of the ExPress miniature glaucoma implant placed under a partial–thickness scleral flap. Methods: Non–comparative case series. 52 eyes of 50 patients underwent ExPress implantation under a scleral flap with Mitomycin C alone (37 eyes) or ExPress implantation under a scleral flap with Mitomycin C combined with phacoemulsification of cataract with insertion of PCIOL (15 eyes) for uncontrolled intraocular pressure by one surgeon. Patients included in this study were otherwise considered candidates for trabeculectomy. Post–operative intraocular pressure readings and complications were recorded, as was the need for argon laser suture lysis, bleb needling and addition of medications to further control pressure. Post–operative success was defined as 22 > IOP > 4 mm Hg with no need for additional pressure–lowering glaucoma surgery. Results:The mean ± SD follow–up time was 4.5 ± 1.9 months (range 2 – 9). Intraocular pressure dropped from a mean ± SD mm Hg pre–operative baseline of 26.3 ± 10.4 to 19.0 ± 2.0 at one week post–op, 15.8 ± 8.6 at one month post–op, 14.3 ± 7.6 at three months post–op and 11.2 ± 3.8 at 6 months post–op(P<0.001). The mean ± SD number of medications was reduced from 3.7 ± 0.9 pre–operatively to 0.4 ± 1.0 at last follow–up(P<0.001). At 6 months follow–up, 95.8% of eyes met criteria for post–operative success. To facilitate flow into the subconjunctival space, 45 eyes (86.5%) received at least one suture lysis and 6 eyes (11.5%) received at least one needling. Five eyes (9.6%) developed hypotony in the post–operative period, and three eyes (5.8%) developed choroidal detachments that resolved spontaneously. Two eyes (3.8%) developed hyphemas that were treated with injection of tissue plasminogen activator. One patient with neovascular glauocma (1.9%) required implantation of an Ahmed Glaucoma Valve due to uncontrolled intraocular pressure and bleb failure. Four eyes (7.7%) were treated for bleb leaks, and three eyes (5.8%) underwent cataract extraction. No patient experienced extrusion or exposure of the ExPress implant. Conclusions: The ExPress implant under a partial–thickness scleral flap represents a safe and effective method of controlling intraocular pressure in patients with glaucoma who are otherwise candidates for trabeculectomy. Further evaluation of the ExPress implant in a comparative controlled setting is warranted.
Keywords: anterior segment • clinical (human) or epidemiologic studies: outcomes/complications