Article Abstract

Clinical outcomes of Ex-PRESS glaucoma shunt in the management of refractory open angle glaucoma

Authors: Chengguo Zuo, Pengli Wang, Shufen Lin, Keling Wu, Mingkai Lin, Jian Ge

Abstract

Objective: To evaluate the efficacy and safety of the Ex-PRESS glaucoma shunt implantation in patients with refractory open angle glaucoma.
Methods: In total, 19 eyes with refractory glaucoma from 19 patients treated in our institution were retrospectively enrolled in this study. All patient underwent Ex-PRESS glaucoma shunt implantation with MMC (2 mg/6~8 mL, 2.5~4 min) and releasable sutures. The demographic features, preoperative and postoperative intraocular pressures (IOPs), best corrected visual acuity (BCVA), anterior chamber depth (ACD), cup-disc ratio (C/D), number of anti-glaucoma medications used, completed and qualified surgery success rates and postoperative complications were recorded to evaluate the outcomes of Ex-PRESS glaucoma shunt implantation.
Results: The complete success rate was 78.9%. Both the qualified success rate and the failure rate were 10.5%. Before surgery, the number of anti-glaucoma medications used was 3~5, and the mean IOP was 27.7±10.1 mmHg. After surgery, only three patients use 1~2 kinds of anti glaucoma medications. The reduction of IOP between groups was significant (P<0.001). Compared with preparation, the mean IOP significantly reduced in 1 day (11.8±7.7 mmHg, P<0.001), 2 weeks (10.1±4.2 mmHg, P<0.05), 1 month (12.0±4.0 mmHg, P=0.001), 6 months (12.2±3.4 mmHg, P<0.001), 1 year (13.1±3.3 mmHg, P=0.001) and 2 years (14.5±2.5 mmHg, P=0.001) follow up. The change of best corrected visual acuity (BCVA),
anterior chamber depth (ACD) and cup-disc ratio (C/D) were not significant. In the last visit, diffuse blebs were observed in 57.9% (11 cases), cystic blebs in 15.8% (3 cases), scarring of the blebs 21.1% (4 cases) and encapsulated filtering bleb 5.3% (1 case). No significant postoperative complications were observed in all patients.
Conclusion: IStent implantation was safe and effective for the management of refractory open angle glaucoma, and it is worth to be popularized.

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