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Editors Selection IGR 9-4

(Laser) Surgical treatment: Ex-PRESS exposure

Comment by Jay Katz 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 Keith Barton •

Find related abstracts

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In this retrospective case series conducted by Stein et al. (1496), eight eyes required explantation of Ex-PRESS shunts in six patients because of exposure. In two cases the shunt had been implanted under a scleral flap and the remainder had been inserted subconjunctivally. There has been support for the placement of the Ex-PRESS shunt because it provides a reproducible, maintained opening into the anterior chamber that negates the need for a peripheral iridectomy. It has been proposed as a replacement for trabeculectomy or tube shunts with reservoirs. Early experience with subconjunctival shunt insertion commonly resulted in exposure of the shunts. This problem spurred the recommendation of placement of the Ex-PRESS shunt under a scleral flap. The justifiable concern raised in this article from exposure of two shunts that had been implanted underneath a scleral flap should alert surgeons that late extrusion may occur months (3-16 months in this study) after Ex-PRESS shunt surgery. It is unclear how prevalent this complication is with insertion under a scleral flap until a report surfaces with long term results pooled from several centers.

Before embracing the Ex-PRESS shunt and recommending it to colleagues and teaching residents and fellows, there needs to be a better grasp of the long-term efficacy and complications of the procedure

Before embracing the Ex-PRESS shunt and recommending the procedure instead of conventional operations, like a trabeculectomy or an equatorial shunt, to colleagues, teaching residents and fellows, there needs to be a better grasp of the long-term efficacy and complications of the procedure. Will there be a large number of future late Ex-PRESS shunt extrusions? The authors noted a reduction in vision in five out of eight eyes after explantation of the shunt. It appears that the removal of the Ex-PRESS shunt and simultaneous glaucoma procedure may not be an easy road.

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