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E. Dahan, T.R. Carmichael; The Surgical Treatment of Neovascular Glaucoma With a 200 Micron Miniature Glaucoma Shunt . Invest. Ophthalmol. Vis. Sci. 2005;46(13):77.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To test the 200 micron ExPRESS glaucoma shunt in neovascular glaucoma (NVG). Methods: A prospective non–randomized pilot study was performed on 12 eyes with NVG due to retinal vein occlusion (RVO) or proliferative diabetic retinopathy (PDR). The surgery consisted of implantation of the ExPRESS 200 micron shunt, under a 6x5mm scleral flap. Mitomycin C 0.2% solution was applied on a 5x4mm area of deep sclerectomy under the scleral flap for 3 minutes prior to the insertion of the ExPRESS shunt. Outcome measures included intra–ocular pressure (IOP), number of anti–glaucoma medications and complications. Results: The group included five Caucasian, one Black and one Indian with RVO; three Black and two Indian with PDR. The overall mean (±SD) IOP preoperatively was 48.7 mmHg (±14.9). The IOP was 50.3 mmHg (±13.6) in the 7 patients with RVO and 46.4 mmHg (±17.8) in the 5 patients with PDR. One year post–operatively the overall mean IOP was 23.7 mmHg (±13.1). In the RVO group it was 21.5 mmHg (±12.9) and in the PDR group it was 28.0 mmHg (±15.1). Pre–operatively all the patients used anti–glaucoma medications. At one year, of the nine evaluable cases, none was using anti–glaucoma medications. Complications consisted of failure of surgery due to bleb fibrosis/uncontrolled rubeosis in six cases and postoperative hyphaemas which occurred in four of the five diabetic patients. None required surgery. There were no episodes of post–operative hypotony. Conclusions: The operation was successful (IOP≤21 mmHg without antiglaucoma medications) in five of seven cases with RVO. The surgery was found to be ineffective in PDR patients with four of the five showing progressive disease and uncontrolled IOP.
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