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Abstract #20086 Published in IGR 9-4
Ex-PRESS R-50 miniature glaucoma implant insertion under the conjunctiva combined with cataract extraction
Rivier D; Roy S; Mermoud AJournal of Cataract and Refractive Surgery 2007; 33: 1946-1952
PURPOSE: To evaluate the efficacy and safety of the Ex-PRESS R-50 implant (Optonol Ltd.) in eyes operated on for open-angle glaucoma combined with phacoemulsification. SETTING: Glaucoma Unit, Ophthalmology Department, University of Lausanne, Lausanne, Switzerland. METHODS: Between November 2000 and June 2002, the Ex-PRESS R-50 shunt was implanted in 35 eyes of 35 patients. The best corrected visual acuity (BCVA), intraocular pressure (IOP), number of medications, and complications were recorded preoperatively as well as postoperatively at one and seven days and one, two, three, six, nine, 12, 24, 36, and 48 months. Temporal clear corneal phacoemulsification with intraocular lens implantation was performed first. The ophthalmic viscosurgical device was not removed, and the Ex-PRESS R-50 was implanted under the conjunctiva into the anterior chamber. RESULTS: The mean follow-up was 36.9 months ± 18.2 (SD) and the mean age of the patients, 74.6 ± 10.9 years. The mean preoperative IOP of 19.3 ± 6.3 mmHg decreased postoperatively to 15.3 ± 6.2 mmHg, 15.1 ± 4.6 mmHg, 13.8 ± 2.8 mmHg, 14.6 ± 2.9 mmHg, and 13.3 ± 2.0 mmHg at six months, 12 months, 24 months, 36 months, and 48 months, respectively (P < .005). At 48 months, the mean BCVA was 0.74 ± 0.34 and the number of medications was reduced by 57% (P < .005). The microtube was removed in ten patients, and bleb management was performed in ten eyes. Ten patients (32%) had satisfactory IOP control (mean 13.2 ± 2.2 mmHg) without medication; minor transient complications were observed in ten patients. Based on the cumulative survival curve after 48 months, the complete success rate was 32.7% and the qualified success rate, 53.7% (P < .05). CONCLUSIONS: Ex-PRESS R-50 implantation under the conjunctiva was associated with a relatively high number of complications, despite good IOP control in the uncomplicated cases. Refinement in the tube design and implantation technique would increase the success rate.
Dr. D. Rivier, Glaucoma Unit, Jules Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland
Classification:
12.8.2 With tube implant or other drainage devices (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
