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Editors Selection IGR 9-1
Surgical management of glaucoma
Comment by Richard Lewis on:
12007 Long term effect on IOP of a stainless steel glaucoma drainage implant (Ex-PRESS) in combined surgery with phacoemulsification, Traverso CE; De Feo F; Messas-Kaplan A et al., British Journal of Ophthalmology, 2005; 89: 425-429
The manuscript by Traverso et al. (339), is a prospective trial placing the Ex-Press implant under a conjunctival flap in combined surgery with phacoemulsification. Although the trial occurred in multiple centers, only 26 eyes of 25 patients were implanted with the device; of these, three were lost to follow-up. The overall success was reported as 76.9% though six patients (23%) were still taking medications at their last follow-up. One of the greatest concerns in surgical device studies is in regards to the side effects. This is especially true in the published reports with the Ex-Press device. The short term complications included six cases of hypotony and three with hyphema. The long term complications were equally troubling including two cases of device malposition and three cases of conjunctival erosion over the device. The role of the Ex-Press shunt in glaucoma surgery with or without phacoemulsification continues to be studied extensively. As pointed out in this manuscript, until efforts are successful to reduce short and long term complications, this procedure should be approached with caution.
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