2018 - 1 Issue

Original article

Use of EX-PRESS® implant in glaucoma surgery - retrospective study

Veronika Fialová ORCID
Martin Váša

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DOI: 10.31348/2018/1/2-1-2018

Published in Czech and Slovak Ophtalmology: 2018 - 1

Published on website: 03.07.2018

Keywords: primary open-angle glaucoma, filtering surgery, EX-PRESS implant

Summary

Purpose: The objective of the study is to evaluate of primary open-angle glaucoma (POAG) with the use of EX-PRESS drainage implant. Evaluated was the decrease of intraocular pressure (IOP), visus stabilization, perimeter Humphrey - related finding (T 30-2), Heidelberg Retina Tomograph (HRT) and possibility of reducing the local drug therapy.

Patients and methods: Retrospective data analysis was performed in 40 eyes with POAG in 28 subjects (14 female- and 14 male patients) average-aged 69.5 years. In all 40 eyes, surgery was performed by one surgeon within the years 2011-2017. Indications for EX-PRESS implantation in our study were the POAG with decompensated IOP, decompensated chronic secondary glaucoma or failure previously anti-glaucoma surgical operations. Within the preoperative period, in all cases the progression was observed on the perimeter T 30-2 or on the HRT. Before and after surgery, all 40 eyes were evaluated for the following factors: the IOP, visus, pachymetry, therapy by anti-glaucomatic drugs and regular inspections of the perimeter and HRT. The average post-surgery following-up time in our total of patients was 3 years and 8 months. The identified data of our total of patients were statistically processed using the Wilcoxon Signed-Rank Test.

Results: The average pre-surgery IOP was 21.4 mm Hg, 6 months post-surgery 11.2 mm Hg, and 13.2 mm Hg at the last inspection. Pre-surgery anti-glaucoma therapy: monotherapy in 2 eyes, dual therapy in 25 eyes, triple therapy in 13 eyes. Post-operatively without the need of therapy were 19 eyes, the need for monotherapy in 7 eyes, dual therapy in 13-eyes and triple therapy in 1 eye. During the last inspection of the perimeter or HRT within the postoperative period, we identified stationary finding in 39 eyes and only a mild progression in 1 eye. Peroperatively, we have not identified any serious complications. Within the postoperative period, we observed choroid ablation in 10 eyes as recovered within 6-7 days. As a more serious complication, we noted endophthalmitis in 1 eye on the background of generalized lichen planus complicating skin disease. In 5 eyes within the late postoperative period we found occlusion of lateral orifices in the EX-PRESS implant by the fibrotic tissue, the 4 eyes developed cataracts, and the eyeball hypotonia persists in 1 eye at the level of 5 torr without affecting the visus of the operated eye.

Conclusion: It outflows from the above results that the use of EX-PRESS implant in the surgery of glaucoma is an effective and safe method with a minimal number of complications.

References

  1. Bing, L., Da-Dong, G., Xiu-Juan, D., et al.: Evaluation of EX-PRESS implantation combined with phacoemuldification in primary angle-closure glaucoma. Medicine (Baltimore). [online]. 2016, Sep, 96(36): e4613. [cit. 2001-01-03]. Dostupné na https://www.ncbi.nlm.nih. gov/pmc/articles/PMC5023874/.
  2. Dahan, E., Carmichael, TR.: Implan - tation of a miniature glaucoma device under a scleral flap. J Glaucoma. 2005, April, 14(2) : 98-102.
  3. Detorakis, E., Stojanovic, N., Chalkia, A. , et al.: EX-PRESS® Implant Position and Function: Comparative Evaluation with Ultrasound Biomicroscopy and Optical Coherence Tomography. J Ophthalmol. 2016, Jan-Mar, 23(1): 110-4.
  4. EX-PRESS. Návod k obsluze zdravotnického prostředku.
  5. Francis, B. A., Sarkisian, S. R. Jr., Tan, J. C.: Minimally invasive glaucoma surgery. A practical guide. New York/Stuttgart, Thieme Publishers. 2016, 236 p. ISBN 978-1-62,623-156-6.
  6. Geffen, N., Trope, GE., Alasbali, T., et al.: Is the Ex-PRESS glaucoma shunt
  7. Kuchynka, P. a kol.: Oční lékařství. 2. Doplněné a přepracované vydání. Praha: Grada Publishing a.s. 2016. 650s.
  8. Lankaranian, D., Razeghinejad, MR., Prasad, A., et al.: Intermediate-term results of the Ex-PRESS miniature glaucoma implant under a scleral flap in previously operated eyes. Clin Exp Ophthalmol. 2011, Jul, 39(5): 421-8.
  9. Leo, J., Antoine, L., Anne-Sophie, A., et al.: Five-year extension of a clinical trial comparing the EX-PRESS glaucoma filtration device and trabeculectomy in primary open-angle glaucoma. Clin Ophthalmol. 2011, 5: 527–533.
  10. Mabray, M., Uzelac, A., Talbott, JE., Lin, SC., et al: Ex-PRESS glaucoma filter: an MRI compatible metallic orbital foreign body imaged at 1.5 and 3 T. Clin Radiol. 2015, May, 70(5): e28-34.
  11. Mariotti, C., Dahan, E., Nicolai, M., et al.: Response to: RE: Long-term outcomes and risk factors for failure with the EX-press glaucoma drainage device. Eye (Lond). 2014, 28:1-8.
  12. Marzette, L., Herndon, LW.: A comparison of the Ex-PRESS™ mini glaucoma shunt with standard trabeculectomy in the surgical treatment of glaucoma. Ophthalmic Surg Lasers Imaging. 2011, 42(6): 453-9.
  13. Mlčák, P., Karhanová, M., Marešová, K.: Chirurgická léčba glaukomu. Praktické lékárenství. 2009, 5(3): 118 s.
  14. Salim, S.: The role of the Ex-PRESS glaucoma filtration device in glaucoma surgery. Semin Ophthalmol. 2013, 28:180– 184.
  15. Samková K., Rejmont L.: Řešení dekompenzovaného sekundárního glaukomu pomocí antiglaukomového implantátu EXPRESS. Čes a slov. Oftal. 69, 2013, 5, s.198-200.
  16. Samsudin, A., Eames, I., Brocchini, S., et al.: Evaluation of Dimensional and Flow Properties of ExPress Glaucoma Drainage Devices. Journal of Glaucoma. 2016, January, Volume 25, Issue 1, pp 39–45.
  17. Seibold, LK. , Rorrer, RA. , Kahook, M.: MRI of the Ex-PRESS stainless steel glaucoma drainage device. Br J Ophthalmol. 2011, Feb, 95(2): 251-4.