Abstract
Abstract: :
Purpose: To report the results of the Ex–PRESSTM glaucoma drainage device as a treatment for patients with advanced, refractory glaucoma. Methods: Review of 11 consecutive cases (July 2002 to September 2003) of Ex–PRESSTM shunt implantation. Indications for surgery included uncontrolled IOP, advanced glaucoma with prior failed glaucoma surgical procedure(s), and poor candidates for trabeculectomy or tube shunt. Outcome measures were pre– and post–operative visual acuity, intraocular pressure (IOP), intraoperative and post–operative tube–related complications, and additional surgical interventions. Failure was defined as requiring shunt removal or bleb needling. Hypotony was defined as IOP<6 mmHg. Results: 11 patients (3 men, 8 women; 10 Caucasian, 1 African–American) ages 22 to 89 (mean 64.2 years) underwent ExPRESSTM shunt implantation. Ten patients (91%) were pseudophakic. Mitomycin C was used in 6/11 cases. 4/11 patients (36%) failed at day 1, 15, 21, and 35 respectively. Failure was independent of mitomycin use. 10/11 patients (91%) experienced hypotony during the first postoperative week, 7 of which resolved spontaneously. Mean duration of hypotony was 36.8±40.1 days (range 1–130). 3/11 (27%) required anterior chamber reformation. 2 (18%) developed suprachoroidal hemorrhage. 3 (27%) developed choroidal detachment, 2 of which resolved spontaneously. Of the non–failures, 4/7 (57%) required one or more additional interventions: anterior chamber reformation (2), drainage of choroidal effusions (1), and drainage of suprachoroidal hemorrhage (1). Mean time to requiring these interventions was 42±41 (range 1–106) days. In the non–failures, there was a mean reduction of IOP of 55% from baseline (mean preoperative IOP = 30.3±9.3 mmHg; mean postoperative IOP at last follow–up = 13.6±4.4 mmHg; p=006). There was no significant change in overall pre– and post–operative visual acuity (mean pre–operative logMAR value = 1.1±0.9; mean post–operative logMAR value = 1.4±0.9; p=0.13). There were no intraoperative complications. Patients were followed for a mean of 35.2±12.8 (range 19–56) weeks. Conclusions: The Ex–PRESSTM shunt may result in significant hypotony, however, with effort it may be possible to achieve successful pressure optimization. The complication rate was high in this small series. While the use of this device in advanced refractory glaucoma may be justified, a randomized study is needed to better evaluate the risks and benefits in less severe cases.
Keywords: clinical (human) or epidemiologic studies: outcomes/complications • intraocular pressure