Evaluation of ExPress glaucoma filtration device in Indian patients with advanced glaucoma

Abstract

ExPress glaucoma filtration device (GFD) has recently become available in India as a surgical option for glaucoma patients. We retrospectively evaluated the outcome of ExPress GFD in 12 eyes with advanced glaucoma with intraocular pressures (IOPs) not controlled on maximal tolerable medical therapy. The mean preoperative IOP of 29.58 ± 7.13 mmHg decreased to 17.0 ± 2.67 and 17.40 ± 0.89 mmHg at 6 and 12 months after surgery. Absolute success (IOP ≤ 18 mmHg, with no additional glaucoma medications) was achieved in eight cases (66.7%) and qualified success (IOP ≤ 18 mmHg, with additional glaucoma medications) in two cases (16.7%) at 1-year after surgery. Early intervention was needed in 4 patients; two underwent anterior chamber reformation while the other two required needling. Two patients required resurgery. There was no significant change in the best corrected visual acuity postoperatively (P = 0.37). ExPress GFD does not seem to offer a benefit over standard trabeculectomy in patients with advanced glaucomatous disease in terms of IOP control or complication rate. However, due to the small sample size with a heterogeneous mixture of primary and secondary glaucoma's, we await further studies with a larger sample size and long-term follow-up, to see how the device performs.

Innovations in glaucoma surgery from Dr. Rajendra Prasad Centre for Ophthalmic Sciences

“…Although published literature suggests equal efficacy and safety of the Ex-PRESS shunt and standard trabeculectomy; our experience with the Ex-PRESS shunt has not been encouraging[26] and we have abandoned its use. However, we developed our own mini-shunt implant (The poor man's Ex-PRESS!…”

An Ex-Press implant versus trabeculectomy in a fibrotic bleb with late failure after previous trabeculectomy

“…The mean preoperative IOP was 29.58±7.13 mm Hg, which decreased to 17.40±0.89. Absolute success was seen in 66.7% of eyes and qualified success in 16.7% of eyes, at the 1-year follow-up [19] . Ex-Press implant was an effective procedure with lower complications when compared to SST in different studies as a primary procedure [20] .…”

“…Postoperative complications were observed in 20 (40.82%) cases [18] . Dewang et al [19] , in another study, clarified the outcome of Ex-Press implant in advanced glaucoma. The diagnosis included primary angle closure glaucoma, POAG, juvenile open angle glaucoma, uveitic glaucoma, and neovascular glaucoma.…”

Ethics of Glaucoma Widgets

“… 33 , 34 Although, advocated as a substitute for trabeculectomy, the ExPress is no longer being used, primarily because of higher cost, a higher rate of failure and complications. 35 …”