Intermediate-term results of the Ex-PRESS miniature glaucoma implant under a scleral flap in previously operated eyes

• Published in: Clinical & experimental ophthalmology 2011-07, Vol.39 (5), p.421-428
• Main Authors: Lankaranian, Dara, Razeghinejad, M Reza, Prasad, Arun, Fakhraie, Ghasem, Freitas, Daniel J, Ichhpujani, Parul, Moster, Marlene R
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Algorithms; Cataract Extraction; Ex-PRESS shunt; Female; Follow-Up Studies; glaucoma; Glaucoma - surgery; Glaucoma Drainage Implants; Humans; Intraocular Pressure; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Sclera - surgery; Surgical Flaps; Tonometry, Ocular; Trabeculectomy; Treatment Outcome
• ISSN: 1442-6404; 1442-9071
• DOI: 10.1111/j.1442-9071.2010.02481.x

Background:  To report the safety and efficacy of Ex‐PRESSTM miniature glaucoma implant under a scleral flap in patients with previous ocular surgeries. Design:  Retrospective, non‐comparative case series from a tertiary care hospital. Participants:  Patients with previous cataract or failed glaucoma surgeries who had undergone implantation of the Ex‐PRESSTM miniature glaucoma implant (R‐50 and T‐50), under a scleral flap, with a minimum of 1‐year postoperative follow up. Methods:  For postoperative outcome, success was defined as complete if intraocular pressure (IOP) was 5–21 mmHg without medication or surgical intervention, and qualified if intraocular pressure was within the same range with glaucoma medication. To compare the outcome between patients who had previous trabeculectomy or cataract surgery the definition of success was intraocular pressure of 5–15 mmHg. Main Outcome Measures:  Intraocular pressure, number of antiglaucoma drugs, visual acuity and complications. Results:  One hundred eyes (100 patients; mean age: 77.4 years) with a mean follow‐up period of 27 ± 13.2 months (range: 12–66) were considered. Success was complete in 60 (60%) and qualified in 24 (24%) eyes. The mean preoperative IOP of 27.7 ± 9.2 mmHg (range: 14–52 mmHg) with 2.73 ± 1.1 drugs declined to 14.02 ± 5.1 mmHg with 0.72 ± 1.06 drugs at the last follow up (P < 0.0001). Causes of failure were uncontrolled intraocular pressure (11%), bleb needling (4%) and persistent hypotony (1%). The probability of success in the patients with previous cataract surgery and trabeculectomy at 3 years was 60.6% and 50.9%, respectively. Conclusions:  The Ex‐PRESSTM implant under scleral flap was a safe and effective glaucoma surgery in the eyes with prior ocular surgery.