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Ricardo Mata, Carolina Prado-Larrea, Luis Laneri Pusineri, Rafael Castañeda, Roberto Gonzalez-Salinas, Jesus Jimenez Roman; Comparison of sutureless scleral tunnel implantation of Ex-Press mini shunt versus conventional technique in patients with glaucoma.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2065.
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© ARVO (1962-2015); The Authors (2016-present)
Compare the surgical outcomes of sutureless scleral tunnel implantation of the Ex-Press mini shunt device versus conventional technique in patients with primary open angle glaucoma (POAG)
A Retrospective, comparative, observational study was carried out. Fourteen eyes were included in the study group and fifteen eyes in the control group. Only patients with POAG and no previous surgery were included.Surgical technique: The conjunctiva was slided forward with a blunt instrument at 8mm from the limbus, a limbus-based scleral tunnel is created at 3mm up to the limbus without entering anterior chamber, MMC 0.01% was applied under the conjunctiva in high-risk cases. A paracentesis with a 25G needle was made under the scleral tunnel, the needle was held parallel to the iris plane and aimed at the center of the pupil. The Ex-press implant was inserted into the anterior chamber via the perforation site through the scleral tunnel and the conjunctiva was closed with a running suture. Data recorded included baseline and postoperative intraocular pressure (IOP), glaucoma medication, visual acuity (VA), visual field mean deviation (DM) and complications
n three months of follow up, the mean baseline IOP significantly decreased from 23.64±5.32 mmHg pre-operatively to 16.07±10.19 mmHg (P<0.0001) in the study group and 20.33±4.8 mmHg to 15.2±2.96 mmHg in the control group (P<0.0001). The number of glaucoma medications decreased from 3.28±0.82 preoperative to 1.21±1.36 three months postoperative in the study group (p=0.0002) and from 3.2±1.01 to 0.4±0.82 (p=0.0001) in the control group.In the early postoperative period one patient in each group had flat anterior chamber. Failure was reported in two patients (14.2%) that required an Ahmed valve implantation for high IOP control in the study group and one patient developed blebitis associated with needling plus 5-FU.
A statistically significant IOP reduction and a decreased number of glaucoma medications was reported in both groups during follow up. The main advantage of this technique, once the learning curve has been surpassed, is a fast and simple glaucoma intervention with clinical improvement
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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