Surgical outcomes of the Ex-PRESS glaucoma filtration device in African American and white glaucoma patients

Salim, Sarwat; Du, Haiming; Boonyaleephan, Sumalee; Wan, Jim Y.

doi:10.2147/opth.s32282

Cited by 14 publications

(9 citation statements)

References 36 publications

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“…This potentially supports biological differences between the groups. In a separate clinical trial, postoperative treatment outcomes for the Ex-PRESS glaucoma filtration device were comparable between African American and Caucasian patients (27). Additionally, glaucoma patients of African descent in St. Lucia experienced greater effectiveness of selective laser trabeculoplasty in reducing IOP by an average of 7.6-8.2 mmHg over the course of a year (28).…”

Section: Genetic Epidemiology Of Poagmentioning

confidence: 99%

Primary Open-Angle Glaucoma Genetics in African Americans

Restrepo

Bailey

2017

Curr Genet Med Rep

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Purpose of review Individuals of African descent are at highest risk for developing primary open-angle glaucoma (POAG), a devastating disease and major contributor of blindness worldwide. Currently, there is a large dearth of knowledge in this area despite a critical need for better understanding the underlying genetic and environmental factors afflicting this population. Here we highlight the current literature exploring the genetics of POAG in African Americans. Recent findings Current studies have yet to replicate European POAG index variants (i.e. CDKN2B-AS1 and SIX1/SIX6) in African Americans or to definitely exclude that these loci contribute to risk in African descent populations. Recent studies have evaluated clinical features that may account for some differences in POAG risk between African Americans and European Americans. Summary In summary, little headway has been made in elucidating the genetics of primary open-angle glaucoma in African Americans and other individuals of African descent.

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Section: Genetic Epidemiology Of Poagmentioning

confidence: 99%

Primary Open-Angle Glaucoma Genetics in African Americans

Restrepo

Bailey

2017

Curr Genet Med Rep

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“…This results in an exuberant healing response, causing contraction of the responsive scars at the site of surgery. 11 - 14 …”

Section: Discussionmentioning

confidence: 99%

Outcomes of Ex-PRESS and Trabeculectomy in a Glaucoma Population of African Origin: One Year Results

Fechtner

2017

Journal of Current Glaucoma Practice

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Aim To compare the efficacy and safety of Ex-PRESS glaucoma filtration surgery to trabeculectomy in African origin patients.Materials and methods A retrospective chart review was performed on 56 African American patients undergoing Ex-PRESS glaucoma shunt (E) or trabeculectomy (T) between 2004 and 2012. Data collected included intraocular pressure (IOP) and glaucoma medication use at baseline and postoperative week 1, Month (M) 1, M3, M6, M12. Postoperative interventions including laser suture lysis (LSL) and 5FU injections were analyzed. Complete and qualified success rate, and eyes failing and requiring more surgery were determined. Means, SD, chi-square, and Student’s t-test were performed.Results A total of 56 subjects (E 28, T 28) were included in the analysis. There was a statistically significant reduction (p < 0.05) in IOP and number of glaucoma medications at all time points compared to baseline for both groups. Extent of IOP reduction between groups was not statistically significant at any time point, except postoperative week 1. Mean number of glaucoma medications between groups was not significant, except at 3 months (lower in EXP group). The cumulative number of postoperative interventions within 3 months (LSL and 5-FU) was significantly greater for the TRAB than EXP (3.89 ± 2.4 vs 2.36 ± 2.2, p = 0.007). Success rates were comparable between both groups (Table 2).Conclusion Our study is unique in patients of African origin showing statistical significance in the requirement of less postoperative 5-FU injections during the first 3 months following surgery in the Ex-PRESS group vs the trabeculectomy group. The Ex-PRESS shunt was as effective as trabeculectomy in reducing IOP and use of glaucoma medications up to 1 year.Clinical significance The possible benefit of this article is to help guiding ophthalmologists to select the type of glaucoma filtration surgery to undergo in an African American patient with glaucoma.How to cite this article Bustros YD, Fechtner R, Khouri AS. Outcomes of Ex-PRESS and Trabeculectomy in a Glaucoma Population of African Origin: One Year Results. J Curr Glaucoma Pract 2017;11(2):42-47.

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“…[ 3 ] Salim et al reported a surgical success (IOP ≤18 mmHg) of 80.0% in the African American group and 83.3% in the white group with the device in POAG patients. [ 4 ] Hirooka et al reported surgical success in 94.8% of 231 eyes at the end of 3 years follow-up. [ 5 ] Other authors have reported results quite similar to trabeculectomy in terms of IOP control.…”

Section: Discussionmentioning

confidence: 99%

“…In our patients, hypotony with shallow AC was noted in 2 patients in the early postoperative period, which did not resolve on medical management and required an AC re-formation. Various authors have reported low rates of hypotony with the ExPress GFD, ranging from as low as 1–4%[ 4 8 9 ] to 15–47.2%. [ 7 9 ] Hirooka et al reported that all instances of hypotony during the early postoperative period resolved spontaneously, with no eyes developing flat AC with lens-cornea touch.…”

Section: Discussionmentioning

confidence: 99%

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

Angmo

Sharma

Temkar

et al. 2015

Indian J Ophthalmol

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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.

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Surgical outcomes of the Ex-PRESS glaucoma filtration device in African American and white glaucoma patients

Cited by 14 publications

References 36 publications

Primary Open-Angle Glaucoma Genetics in African Americans

Primary Open-Angle Glaucoma Genetics in African Americans

Outcomes of Ex-PRESS and Trabeculectomy in a Glaucoma Population of African Origin: One Year Results

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

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