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Abstract #26717 Published in IGR 12-3
Experience with Ex-PRESS shunt in pediatric glaucoma
Crouch EJournal of AAPOS 2010; 14: 14
Purpose: To investigate the efficacy and safety of the Ex-PRESS (Optonol Ltd., Neve Ilan, Israel) mini glaucoma shunt in pediatric and juvenile glaucoma. Methods: We performed a retrospective chart review study of consecutive patients undergoing Ex-PRESS shunt insertion. Seven eyes from five patients were treated for glaucoma unresponsive to medical management. The main outcome measures were: mean intraocular pressure (IOP), postoperative medication use, visual acuity, and incidence of complications. Complete success was defined as an IOP<18 mm Hg at 6 months without the use of anti-glaucoma medications. Partial success was defined as an IOP of<18 mm Hg at 6 months with a reduction in anti-glaucoma medications. There were 5 patients (7 eyes) with juvenile glaucoma or aphakic glaucoma in the study. There were no cases of congenital glaucoma or microphthalmia in the study. All patients received an R-50 Ex-PRESS shunt. The past surgical history for all patients combined included six trabeculectomies and three endoscopic cyclophotocoagulation ablations. Four eyes had no previous surgery, but were offered the option of a trabeculectomy or Ex-PRESS shunt. Results: The proportion of patients achieving an IOP<18 mm Hg without any medication at 6 month follow-up were 57% (4 of 7 patients). Patients with reduced medications and IOP<18 mm Hg, but excluding patients on no medications, were 14% (1 of 7 patients). Two patients maintained the same preoperative anti-glaucoma medications, but did have reduced intraocular pressures (14 mm Hg and 23 mm Hg). The average preoperative intraocular pressure was 41.6 mm Hg. The average and median postoperative intraocular pressures were 15.3 mm Hg and 14 mm Hg, respectively. Average improvement in best corrected visual acuity was 2.1 lines. Postoperative interventions and complications included viscoadaptive anterior chamber reformation (n = 4), decompressive retinopathy (n = 2), and scleral flap revision (n = 2). There were no cases of choroidal detachment, hypotonus maculopathy, conjunctival revisions, blebitis, or endophthalmitis. Conclusions: In juvenile and aphakic glaucoma, the Ex-PRESS mini glaucoma shunt implanted under a scleral flap provides an effective reduction in intraocular pressure. Management of postoperative complicationswas straightforward and well tolerated. The Ex-PRESS is a safe and effective device for treating juvenile and aphakic glaucoma and provides an alternative to trabeculectomy or an intermediate option between trabeculectomy and traditional glaucoma shunt surgery.
E. Crouch.
Classification:
12.8.2 With tube implant or other drainage devices (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
9.1.2 Juvenile glaucoma (Part of: 9 Clinical forms of glaucomas > 9.1 Developmental glaucomas)