Intermediate-term results of the Ex-PRESS miniature glaucoma implant under a scleral flap in previously operated eyes.

BACKGROUND

To report the safety and efficacy of Ex-PRESS(TM) miniature glaucoma implant under a scleral flap in patients with previous ocular surgeries.

DESIGN

Retrospective, non-comparative case series from a tertiary care hospital.

PARTICIPANTS

Patients with previous cataract or failed glaucoma surgeries who had undergone implantation of the Ex-PRESS(TM) miniature glaucoma implant (R-50 and T-50), under a scleral flap, with a minimum of 1-year postoperative follow up.

METHODS

For postoperative outcome, success was defined as complete if intraocular pressure (IOP) was 5-21 mmHg without medication or surgical intervention, and qualified if intraocular pressure was within the same range with glaucoma medication. To compare the outcome between patients who had previous trabeculectomy or cataract surgery the definition of success was intraocular pressure of 5-15 mmHg.

MAIN OUTCOME MEASURES

Intraocular pressure, number of antiglaucoma drugs, visual acuity and complications.

RESULTS

One hundred eyes (100 patients; mean age: 77.4 years) with a mean follow-up period of 27 ± 13.2 months (range: 12-66) were considered. Success was complete in 60 (60%) and qualified in 24 (24%) eyes. The mean preoperative IOP of 27.7 ± 9.2 mmHg (range: 14-52 mmHg) with 2.73 ± 1.1 drugs declined to 14.02 ± 5.1 mmHg with 0.72 ± 1.06 drugs at the last follow up (P < 0.0001). Causes of failure were uncontrolled intraocular pressure (11%), bleb needling (4%) and persistent hypotony (1%). The probability of success in the patients with previous cataract surgery and trabeculectomy at 3 years was 60.6% and 50.9%, respectively.

CONCLUSIONS

The Ex-PRESS(TM) implant under scleral flap was a safe and effective glaucoma surgery in the eyes with prior ocular surgery.