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Editors Selection IGR 11-4
Surgical management of glaucoma
Comment by Richard Lewis on:
11727 Implantation of a miniature glaucoma device under a scleral flap, Dahan E; Carmichael TR, Journal of Glaucoma, 2005; 14: 98-102
Dahan et al. (332) published a retrospective study of the Ex-Press glaucoma device placed under the scleral flap in eyes noted to be at high risk for filtering surgery. At one and two years the IOP was reduced from 27.2 to 14.5 and 14.2 respectively. There are limitations in evaluating this (or any) study without a control group including the small sample size (24 eyes of 23 patients), and possible bias from a lack of randomization and masking. These results limit the ability to generalize the results to various types of glaucoma diagnosis. However, the study does detail an alternative approach to placing the Ex-Press device under a scleral flap. The manuscript also raises some interesting questions about the efficacy and complications of the Ex-Press one year after implantation. In this regard, two of the 24 patients or 8% required anti glaucoma medications for pressure control. A larger sample size and randomized prospective study will be of great value in answering these questions.
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