Abstract
Purpose :
To compare the safety and efficacy of patients undergoing Ex-PRESS miniature glaucoma shunt insertion alone (EMGS) with those combined with phacoemulsification (p-EMGS).
Methods :
A retrospective chart review of 230 eyes of 198 patients with various types of glaucoma undergoing EMGS (N=99) or p-EMGS (N=131) were reviewed over a two year period. Intraocular pressure (IOP), number of glaucoma medications, visual acuity (CDVA), post-operative complications, and need for additional surgeries were analyzed.
Results :
Despite a significant difference in the pre-operative IOP of those undergoing EMGS, 25.1 ± 11.05 mmHg (p<0.01), and p-EMGS, 20.4 ± 9.0 mmHg, both groups had a significant decrease in IOP at 24 months of 11.34 ± 8.76 mmHg and 8.62 ± 10.14 mmHg, respectively.
A significant difference in number of pre-operative glaucoma medications existed between the EMGS group, 3.39 ± 0.96 (p<0.01) and the p-EMGS group, 2.84 ± 0.86. At 24 months, there was a significant reduction in the glaucoma medications in both groups, but no significant difference was observed between EMGS 0.60 ± 1.17 and p-EMGS 0.77 ± 1.09.
Preoperative visual acuity was not statistically different between the two groups. As expected, the p-EMGS group was observed to have significantly improved vision, whereas the EMGS group had no change from baseline.
Both groups had low rates of severe complications, 1.0% for EMGS (n=1, retinal tear) and 1.5% for p-EMGS (n=2, choroidal hemorrhage). There was no significant difference in the need for additional surgeries between the two groups.
Conclusions :
Ex-PRESS miniature glaucoma shunt insertion demonstrated excellent IOP reduction both alone and combined with phacoemulsification throughout the 24 month study period. For those glaucoma patients who have concomitant visually significant cataracts, p-EMGS is a safe and efficacious procedure as compared to EMGS alone, potentially reducing the costs and complications associated with sequential cataract surgery.
This is a 2020 ARVO Annual Meeting abstract.