[Ex-PRESS miniature glaucoma implant inserted under a scleral flap in open-angle glaucoma surgery: a retrospective study]

Abstract

Purpose: (1) To present the Ex-PRESS device implanted under a scleral flap in open-angle glaucoma patients and to report its safety and efficacy; (2) to compare the results obtained without a scleral flap in a glaucoma group.

Patients and methods: The case series studied included the eyes of Caucasian patients (82 patients, 99 eyes) with open-angle glaucoma, operated on between January 2003 and June 2004. The Ex-PRESS devices were inserted under the scleral flap in the anterior chamber; if necessary a combined surgery was performed (28 eyes). Each patient underwent ophthalmic examinations (IOP, visual field, gonioscopy, cup/disc ratio) before and after the operation. The surgical procedure lasted between 10 and 20 min with topical anesthesia. An antimetabolite was used under the scleral flap for all patients. The mean follow-up was 7.5+/-4.6 months; 40% had 12 months follow-up (40 eyes).

Results: The IOP decreased from 22.9+/-5.3 mmHg preoperatively to 14+/-2 mmHg at 6 months and 14.3+/-2.3 mmHg at 1 year. The success rate was 86.9% (IOP below 21 mmHg with or without drugs). Complete success was achieved in 62.6% (IOP below 21 mmHg without anti-glaucoma drops or medications). In 13 eyes, IOP was not controlled with eye drops, and nine eyes had to be reoperated. Six cases presented athalamia but recovered without surgical treatment. We did not observe any infection, corneal erosion, or Ex-PRESS extrusion. There were no statistical differences between results obtained with and without scleral flap regarding IOP or early complications (athalamia).

Conclusion: Both the safety and the efficacy of the device under a scleral flap were showed in glaucoma surgery in this retrospective study. Using the scleral flap reduces the risk of erosion but confirmation with a longer follow-up is needed.