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Editors Selection IGR 11-1
(Laser) Surgical treatment: Ex-PRESS exposure
Comment by Keith Barton on:
20124 Exposure of Ex-PRESS Miniature Glaucoma Devices: Case series and technique for tube shunt removal, Stein JD; Herndon LW; Bond JB et al., Journal of Glaucoma, 2007; 16: 704-706
See also comment(s) by Jay Katz •Stein et al. (1496) performed a retrospective clinical series of Ex-PRESS aqueous shunts that were removed because they eroded through the overlying conjunctiva. All of these shunts were referred to the authors' practice for management of conjunctival erosion and therefore this article cannot be used to estimate the frequency that erosion occurs with these particular types of shunt. Nevertheless, the presentation of six patients (eight eyes) with the same complication in just under two years, suggests that erosion might not be uncommon with this particular shunt. It is interesting that most erosions presented in shunts that were not placed under a scleral flap, and that those eroding through a scleral flap had been exposed to Mitomycin C.
Erosion might not be uncommon the Ex-PRESSThe purpose of the study was to report a removal technique that the authors found useful. Clearly in a shunt with a barb or spur, an extra manipulation is required to remove this part of the shunt from the eye safely and atraumatically. The authors achieved this using a clever technique whereby they make a small track adjacent to the shunt, dislodge the shunt towards the anterior chamber and then rotate it so the spur can be removed through the new track. Interestingly, the wound was closed successfully with a scleral patch alone. When other types of aqueous shunts (Ahmed, Baerveldt, Molteno) are resited, the hole left behind is often too large to leave unsutured (approximately 600 μm external diameter), and it is fortuituous that the Ex-PRESS has a smaller footprint allowing the site to be closed more easily as suturing larger shunt tracks is often challenging.
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