Search

Purpose: Uveitis can lead to secondary glaucoma, a condition with challenging management that can carry irreversible visual loss. Filtering surgery has demonstrated a higher failure rate, increased incidence of postoperative complications and reinterventions in uveitic patients. There is no consensus on the optimal surgical approach for uveitic glaucoma (UG) due to limited data comparing various intraocular pressure (IOP)-lowering surgeries. This retrospective cohort aims to assess the clinical outcomes of trabeculectomy (TBT), non-penetrating deep sclerectomy (NPDS), Ex-PRESS shunt and Ahmed glaucoma valve, providing additional insights into the long-term IOP control and safety of filtering surgeries in UG. Methods: The filtering surgery was performed on 32 eyes of 27 UG patients. Complete success was defined as IOP ≤ 18 mmHg or a 30% reduction. Qualified success allowed topical hypotensive treatment. Results: Complete success was 40.63% (13/32) at 12 months and 36.67% (11/30) at 36 months. Qualified success was 84.38% (27/32) at 12 months and 63.33% (19/30) at 36 months. In the survival analysis, both NPDS and Ex-PRESS demonstrated decreased failure rates compared to TBT (NPDS vs TBT: HR = 0.20, p = 0.049; Ex-PRESS vs TBT: HR = 0.28, p = 0.13). One or more reinterventions were required in 34.38% (11/32) of the eyes. NPDS had the lowest incidence of hypotony. Secondary cataract was a common complication in all groups. Conclusion: Various filtering surgeries are safe and effective procedures for lowering IOP and reducing the requirement of topical antihypertensives in UG at 36 months. However, one-third of the patients will require another IOP-lowering procedure. [ABSTRACT FROM AUTHOR]

Mitsuya Otsuka, Naoki Tojo, Hitoshi Yamazaki, Tomoko Ueda-Consolvo, Atsushi Hayashi Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, JapanCorrespondence: Atsushi Hayashi, Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama City, 930-0194, Japan, Tel +81-76-434-7363, Fax +81-76-434-5037, Email ahayashi@med.u-toyama.ac.jpPurpose: We compared the corneal endothelial cell loss between trabeculectomy (Trab) and Ex-Press® surgery (EXP) for low-intraocular pressure (IOP) glaucoma patients.Patients and Methods: This was a single-facility retrospective study. We analyzed the cases of patients with primary open-angle glaucoma (POAG) and pre-operative IOP ≤ 21 mmHg who had undergone Trab or EXP surgery and were followed for > 3 years. Noncontact specular microscopy was used to determine the corneal endothelial cell density (CED) before and after Trab or EXP surgery. We measured the CED at 12, 24, and 36 months post-surgery. We compared the CED values and CED survival ratio after both surgeries using paired t-tests.Results: We included 39 eyes that underwent Trab and 36 eyes that underwent EXP surgery. In the Trab group, the mean CED value had decreased from 2333 ± 399 at baseline to 2066 ± 587 cells/mm2 after 3 years. In the EXP group, the mean CED value had decreased from 2320 ± 393 at baseline to 2229 ± 460 cells/mm2 after 3 years. The survival ratio of CED at > 3 years was 89.3 ± 14.2% (Trab group) and 95.6 ± 11.1% (EXP group); compared to the Trab surgery, the EXP surgery thus significantly decreased the CED loss (p = 0.037). No case resulted in bullous keratopathy.Conclusion: Compared to trabeculectomy, Ex-Press® surgery appears to be a safer surgical method with regard to the endothelial cell loss risk.Keywords: Ex-Press, glaucoma, corneal endothelial cell, trabeculectomy

Purpose: We compared corneal endothelial cell (CED) loss after Ex-Press (EXP) surgery between patients with primary open-angle glaucoma (POAG) and pseudo-exfoliation glaucoma (PEX). Patients and methods: This was a single-facility retrospective study. We included glaucoma patients who had undergone EXP surgery and were followed up > 3 years. We measured the CED before and after (at 12, 24, and 36 months) EXP surgery by noncontact specular microscopy and compared the means of the CED values and CED survival ratios after EXP surgery by paired t-test. Results: We included 119 eyes that underwent EXP surgery, including 60 POAG eyes and 59 PEX eyes. In the POAG group, the mean CED decreased from 2389 ± 321 at baseline to 2230 ± 424 cells/mm2 after 3 years. In the PEX group, the mean CED decreased from 2111 ± 510 at baseline to 1845 ± 628 cells/mm2 after 3 years. At the 3-year follow-up, the CED survival ratio was 93.3 ± 12.5% in the POAG group and significantly lower, at 85.0 ± 19.5%, in the PEX group (p = 0.0064). Two cases in the PEX group developed bullous keratopathy. Conclusions: EXP surgery decreased the corneal endothelial cell populations in PEX patients faster than POAG patients. [ABSTRACT FROM AUTHOR]

Introduction: Among published papers on efficient combined treatment of glaucoma and cataract there are limited conclusions indicating the unambiguous advantages of one particular, currently available method. The classic approach of phacotrabeculectomy has many alternatives including Ex-PRESS implantation performed simultaneously with phacoemulsification. These procedures can also be performed on pseudophakic eyes. The aim of this study was to determine any possible advantages and disadvantages of each method and to compare them. Material and methods: Records of 105 eyes of 77 patients, who had undergone either trabeculectomy or Ex-PRESS P-200 implantation between the years 2017 and 2022, have been retrospectively reviewed and evaluated for outcomes and complications. Results: The study of 105 eyes showed no statistically significant differences between the groups regarding the need for additional medical procedures after the treatment. Significant differences were observed in postoperative BCVA (best corrected visual acuity) scores for the phacoEx-PRESS and phacotrabeculectomy groups compared to the trabeculectomy in pseudophakic eyes and Ex-PRESS in pseudophakic eyes groups. Intraocular pressure measurements showed a significant improvement in their values for all groups. When comparing the different groups, a significant difference was discovered between the Ex-PRESS in the pseudophakic eyes group and the trabeculectomy in pseudophakic eyes and phacotrabeculectomy groups. Complications of the procedures occurred in each group; however, the trabeculectomy in pseudophakic eyes and phaco-Ex-PRESS groups differed significantly. Conclusions: The efficiency and safety of Ex-PRESS surgery and trabeculectomy, either on pseudophakic eyes or combined with phacoemulsification is similar and every approach provides acceptable results. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the postoperative intraocular pressure (IOP) control and identify the factors associated with failure of initial Ex-PRESS surgery in patients with open-angle glaucoma for 3 years. Methods: A total of 79 patients with medically uncontrolled open-angle glaucoma (55 normal-tension glaucoma and 24 primary open-angle glaucoma) were enrolled. All patients underwent Ex-PRESS implantation (including combined cataract surgery). The outcome measure was the survival rate using life table analysis, the failure was defined as IOP of > 18 mmHg (criterion A), > 15 mmHg (criterion B) or > 12 mmHg (criterion C) and/or IOP reduction of < 20% from baseline (each criterion) without any glaucoma medications. The Cox proportional hazards model was used to identify risk factors for IOP management defined as the above criterion. Results: The mean preoperative IOP was 19.3 ± 5.8 mmHg. At 36 months, the mean IOP was 11.8 ± 3.6 mmHg with a mean IOP change of 7.5 mmHg (reduction rate 39.0%). The cumulative probability of success was 58% (95%CI: 42–64%) (criterion A), 48% (95%CI: 37–59%) (criterion B) and 30% (95%CI: 20–40%) (criterion C). In multivariate analyses, factors that predicted poor IOP control included the intervention of bleb needling after 6 months after the surgery (HR: 2.43; 95%CI: 1.35–4.37; P = 0.032). Transient hypotony was observed in 4 patients. Conclusion: The implementation of bleb needling after Ex-PRESS surgery in the late postoperative period was suggested to be the main risk factor for achieving lower IOP. [ABSTRACT FROM AUTHOR]

Purpose: Previously, we reported that the Ex-press® shunt (EXP) was associated with more rapid reduction in corneal endothelial cells when inserted into the cornea rather than the trabecular meshwork (TM). We compared the reduction rate of corneal endothelial cells between the corneal insertion group and TM insertion group. Methods: This was a retrospective study. We included patients who had undergone EXP surgery and were followed for > 5 years. We analyzed the corneal endothelial cell density (ECD) before and after EXP implantation. Results: We included 25 patients in the corneal insertion group and 53 patients in the TM insertion group. One patient in the corneal insertion group developed bullous keratopathy. The ECD decreased significantly more rapidly in the corneal insertion group (p < 0.0001), in whom the mean ECD decreased from 2227 ± 443 to 1415 ± 573 cells/mm2 at 5 years with a mean 5-year survival rate of 64.9 ± 21.9%. By contrast, in the TM insertion group, the mean ECD decreased from 2356 ± 364 to 2124 ± 579 cells/mm2 at 5 years, and the mean 5-year survival rate was 89.3 ± 18.0%. The decrease rate of ECD was calculated as 8.3%/year in the corneal insertion group and 2.2%/year in the TM insertion group. Conclusions: Insertion into cornea is a risk factor for rapid ECD loss. The EXP should be inserted into the TM to preserve the corneal endothelial cells. [ABSTRACT FROM AUTHOR]

Purpose: To compare surgical outcomes of Ex-PRESS® (EXP) surgery for primary open-angle glaucoma (POAG) between low preoperative intraocular pressure (IOP) and high preoperative IOP. Methods: This was a retrospective non-randomized study. Seventy-nine POAG patients who underwent EXP surgery and were followed for > 3 years were included. Patients with a preoperative IOP of ≦ 16 mmHg and > 16 mmHg with tolerant glaucoma medications were defined as the low IOP group and the high IOP group, respectively. We compared the surgical outcomes, postoperative IOP and number of glaucoma medications. Success was defined as a postoperative IOP of ≦ 15 mmHg and a reduction of > 20% from the preoperative IOP to the postoperative IOP. Results: EXP surgeries significantly decreased IOPs from 13.2 ± 2.0 to 9.1 ± 2.9 mmHg in the low IOP group (p < 0.001), and from 22.5 ± 4.8 to 12.5 ± 4.0 mmHg in the high IOP group (p < 0.001). The mean postoperative IOP was significantly low in the low IOP group at 3 years (p = 0.0008). Success rates compared using the Kaplan–Meier survival curve were not significantly different (p = 0.449). Conclusions: EXP surgery was useful for POAG patients with a low preoperative IOP. [ABSTRACT FROM AUTHOR]

Purpose: To compare surgical and refractive outcomes in patients undergoing trabeculectomy and Ex-Press implantation surgery. Materials and Methods: The study included 40 eyes underwent trabeculectomy (n=20) and Ex-Press implant (n=20) due to uncontrolled glaucoma. Best corrected visual acuity (BCVA), intraocular pressure (IOP), and keratometry measurements were evaluated preoperatively and on postoperative months 1, 3 and 6 months. During the follow-up, keratometric astigmatism values and surgery-induced astigmatism (SIA) values calculated with Eğrilmez's vector analysis program were analyzed using statistical comparisons. Results: There were no significant differences in mean age, gender, laterality and glaucoma type (p>0.05) between study groups. Again, no significant differences were found in mean baseline BCVA (0,35±0,36, 0,46±0,33 logMAR), IOP (32,10±7,8, 37,10±8,3 mmHg), keratometry (43, 93±1,16, 43,71±0,61 D), and corneal astigmatism (1,10±0,61, 0,83±0,40 D) (p>0.05) values between trabeculectomy and Ex-Press implant groups. In the Ex-Press group, postoperative IOP reduction was significantly greater on month 1(14,10±4,2, 10,95±2,2 mmHg, p=0.013), but no significant difference was found between the two groups at remaining time points (p>0.05). Corneal astigmatism increased in both groups in the first month, but this increase was not statistically significant (p>0.05). There was no significant difference SIA vector size during the 6-months follow-up between groups (p>0.05). While oblique astigmatism was present in the trabeculectomy group at baseline, rule-compliant astigmatism was observed on postoperative month 6. In the Ex-Press group, the rule-compliant component persisted throughout follow-up period. Conclusions: No significant difference occurred in IOP, visual outcomes, and astigmatism change after trabeculectomy and Express implantation. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the risk factors for Ex-Press® (EXP) surgery failure. Patients and methods: This was a retrospective non-randomized study of 98 patients who had undergone EXP and were followed up ≥ 5 years. We investigated the following nine risk factors: age, gender, hypertension, diabetes mellitus (DM), previous glaucoma surgery, type of glaucoma (primary open-angle glaucoma vs. pseudo-exfoliation glaucoma), surgical methods (EXP alone vs. EXP + cataract surgery simultaneously), central corneal thickness (CCT), and preoperative intraocular pressure (IOP). We defined a successful surgery as a postoperative reduction in the IOP ≥ 20% from the preoperative IOP and ≤ 18 mmHg. We determined the risk factors using multivariate cox regression models. Results: Performing EXP significantly decreased the IOP (preoperative: 25.2 ± 8.7, at 5 years: 11.1 ± 4.1). The success ratio of EXP was 67.4% at 5 years. We found no significant risk factors for EXP surgery failure. The p values of the factors were age (p = 0.936), gender (p = 0.0587), hypertension (p = 0.409), DM (p = 0.967), previous glaucoma surgery (p = 0.940), type of glaucoma (p = 0.435) surgical methods (p = 0.521), CCT (p = 0.091), and preoperative IOP (p = 0.082). Conclusions: No preoperative factors that could be used to predict the failure of EXP surgery were identified. EXP can be safely performed for primary open-angle glaucoma and pseudo-exfoliation glaucoma. [ABSTRACT FROM AUTHOR]

Abstract Background To evaluate the postoperative outcomes of initial trabeculectomy (Trab) and Ex-PRESS (EX) in terms of achieving an intraocular pressure (IOP) below 15 and 18 mmHg. Methods This study retrospectively analyzed 64 and 54 cases of Trab and EX, respectively, performed by the same surgeon with uniform management from April 2018 to March 2019. Surgical success was defined as 5

AIM: To evaluate the efficacy and safety of modified trabeculectomy (experimental group) and implantation of EX-PRESS drainage device (control group), combined with intravitreal conbercept injection for neovascular glaucoma (NVG). METHODS: Totally 30 patients with NVG were selected from June 2014 to June 2017, and randomly divided into experimental group and control group. All patients were underwent intravitreal conbercept (0.5 mg/0.05 mL) treatment before surgery. Modified trabeculectomy was performed in MT group, while EX-PRESS drainage device implantation was performed in EX group. The success rates, best corrected visual acuity (BCVA), intraocular pressure (IOP), filtering bleb and complications were observed and compared. RESULTS: The differences of success rate, BCVA and filtering bleb were not statistically significant 12mo after the surgery (P>0.05), however, the difference of IOP at 1d, 1wk, 1, 3, and 6mo after surgery was statistically significant (Ftime=390.64, Ptime0.05), while the results at other time point indicate statistical differences (P

Abstract Background To compare the efficacy of Ex-PRESS implantation versus trabeculectomy combined with phacoemulsification. Methods A retrospective 12-month study on patients with coincident primary open-angle glaucoma (POAG) and cataract. The patients underwent combined phacoemulsification and Ex-PRESS implant (Phaco-ExPRESS, n = 35) or phacotrabeculectomy (Phaco-Trab, n = 35). The morphological structures of the filtering bleb were examined by slit-lamp, anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM). Complete success was defined as postoperative intraocular pressure (IOP)

Purpose: To compare surgical outcomes between Ex-PRESS® surgery (EXP) and trabeculectomy (Trab) for primary open-angle glaucoma (POAG) with low preoperative intraocular pressure (IOP). Patients and methods: This was a retrospective non-randomized study. We included POAG patients with preoperative IOP ≤ 16 mmHg who were taking tolerance glaucoma medications. We compared the surgical outcomes, postoperative IOP, number of glaucoma medications, reduction rate of corneal endothelial cell density (ECD), visual acuity, and postoperative complications between POAG patients who underwent EXP (34 eyes) or Trab (38 eyes) and could be followed up for > 2 years. Results: Both surgeries significantly decreased the IOP (p < 0.001): At 2 years, EXP provided decreases from 13.4 ± 2.3 to 10.2 ± 3.1 mmHg, and Trab provided decreases from 13.5 ± 2.0 to 8.9 ± 3.2 mmHg. No significant differences were observed in the postoperative IOP (p = 0.076), number of postoperative medications (p = 0.263), success rate (p = 0.900), reduction rate of ECD (p = 0.410), or difference in visual acuity (p = 0.174). The reduction rate of IOP was significantly high in the Trab group (p = 0.047). Conclusions: Both surgeries significantly decreased IOP and were useful surgical methods for low-IOP glaucoma. Our results suggest that trabeculectomy can decrease IOP more than Ex-PRESS surgery but might have more complications. [ABSTRACT FROM AUTHOR]

Our purpose is to evaluate long-term changes in corneal endothelial cells after Ex-PRESS shunt implantation for the treatment of glaucoma in Chinese patients by comparison with the contralateral eye. In this retrospective observational study, glaucoma patients with a single eye undergoing Ex-PRESS shunt implantation surgery were consecutively enrolled. For each patient, the clinical assessment, including corneal endothelial cell density (CECD) before surgery and at 6, 12 months, and at last follow-up (2.43 ± 0.63 years) after surgery was reviewed. The operated eyes were in the study group and the unoperated contralateral eyes were used as the control group to compare the CECD change. A total of 48 subjects (age, 51.02 ± 17.96 years) were included. The follow-up period was 2.08~3.17 years, with an average of 2.43 ± 0.63 years. At the last follow-up after the surgery, the CECD decrease in the operated eyes (5.0%) was similar to that in the contralateral eyes (3.2%) (p = 0.130). There were no significant differences in CECD reduction between the two groups at baseline and each postoperative follow-up (6 months, 12 months and at the last follow-up) (all p > 0.05). The average IOP reduction after the surgery was 50.8%, and the number of IOP-lowering medications was significantly reduced (p < 0.05). In addition, visual acuity showed no significant differences during follow-up (p > 0.05). In this study, we found that the CECD reduction of Ex-PRESS shunt-implanted Chinese eyes was similar to that of contralateral eyes without surgery. [ABSTRACT FROM AUTHOR]

Purpose: We compared the corneal endothelial cell loss between trabeculectomy (Trab) and Ex-Press ® surgery (EXP) for low-intraocular pressure (IOP) glaucoma patients., Patients and Methods: This was a single-facility retrospective study. We analyzed the cases of patients with primary open-angle glaucoma (POAG) and pre-operative IOP ≤ 21 mmHg who had undergone Trab or EXP surgery and were followed for >3 years. Noncontact specular microscopy was used to determine the corneal endothelial cell density (CED) before and after Trab or EXP surgery. We measured the CED at 12, 24, and 36 months post-surgery. We compared the CED values and CED survival ratio after both surgeries using paired t-tests., Results: We included 39 eyes that underwent Trab and 36 eyes that underwent EXP surgery. In the Trab group, the mean CED value had decreased from 2333 ± 399 at baseline to 2066 ± 587 cells/mm2 after 3 years. In the EXP group, the mean CED value had decreased from 2320 ± 393 at baseline to 2229 ± 460 cells/mm 2 after 3 years. The survival ratio of CED at >3 years was 89.3 ± 14.2% (Trab group) and 95.6 ± 11.1% (EXP group); compared to the Trab surgery, the EXP surgery thus significantly decreased the CED loss (p = 0.037). No case resulted in bullous keratopathy., Conclusion: Compared to trabeculectomy, Ex-Press ® surgery appears to be a safer surgical method with regard to the endothelial cell loss risk., Competing Interests: No potential conflict of interest was reported by the authors., (© 2024 Otsuka et al.)

Copyright of MN Opthalmology / MN Oftalmoloji is the property of Medical Network and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose. To evaluate antihypertensive efficiency and safeness of Xenoplast, Glautex, and Ex-PRESS drainage during glaucoma surgery. Material and methods. 249 patients with primary open angle glaucoma (253 eyes) underwent antihypertensive operations with Xenoplast (group I, 121 patients aged 68.6 ± 7.7 yrs), Glautex (group II, 49 patients aged 66.8 ± 7.7 yrs) and Ex-PRESS (group III, 79 patients aged 67.9 ± 8.3 yrs). In groups I and II, drainages were implanted during penetrating and non-penetrating surgery. Long-term results were traced for 2 years. Results. In the early postoperative period, all groups had complications typical for antiglaucoma surgery without drainage: I — 14.8 %, II — 16.8 %, III — 16.8 %. An absolute success of the operation (normalization of IOP without additional antihypertensive therapy) was achieved as follows. In group I for patients with non-penetrating deep sclerectomy it was achieved in 98.4 % of cases at the moment of discharge from hospital, whereupon the figure fell to 15.4 % in 18 months. In group I patients, with trabeculectomy the success was achieved in 96.7 %, dropping to 6.7 %. In group II for patients with non-penetrating deep sclerectomy the success claimed 96.3 %, but after 12 months it vanished completely. In group II with trabeculectomy the success reached 95.7 %, but dropped to 16.7 % after 24 months. In group III the success rate at the moment of discharge was 96.3 % but it dropped to 16.7 % after 24 months. In cases if target pressure could not be achieved the surgery was repeated. Conclusion. The absolute success originally achieved in all groups (96.3–98.4 %) was not persistent and after a 2-year observation, tended to disappear. The effect lasted longer in eyes after trabeculectomy with Glautex and Ex-PRESS. The hypotensive effect of primary antiglaucoma surgery was higher in penetrating operations.

PurposeTo investigate the effect of microincision vitreous surgery (MIVS) on intraocular pressure (IOP) control in glaucomatous eyes with functional filtering bleb.MethodsWe enrolled 18 patients (15 males; median age, 73 years) who previously had filtering surgery and underwent MIVS with functional filtering bleb. Kaplan–Meier method was used to calculate the survival rate with defined the failure as when more number of preoperative antiglaucoma medication was started or additional glaucoma surgery including bleb revisions were performed, and IOP increase of 20% (criteria 1) and 30% (criteria 2) from preoperative levels after 2 weeks of MIVS.ResultsThe median follow-up duration was 970 days. Preoperative IOP was 13.3 ± 3.8 mmHg (mean ± SD). Postoperative IOP were 14.7 ± 4.9 (P=0.365), 15.2 ± 3.5 (P=0.137), 16.4 ± 5.6 (P = 0.073), 17.6 ± 6.1(P = 0.020), and 14.5 ± 4.0 (P = 0.402) mmHg at 3, 6, 12, and 15 months and final visit, respectively (compared to preoperative IOP). The number of antiglaucoma medications was a median of 1.0 (range 0–4) preoperatively and 0 (0–4) at the final visit (P = 0.238). The survival rates were 55%/61% at 3 months, 50%/61% at 6 months, and 38%/55% at 12 months with criteria 1 and 2, respectively. Four eyes (22%) received additional glaucoma surgery during follow-up.ConclusionAfter several months of MIVS, IOP was likely to increase. We should focus on IOP control by conducting long-term follow-ups.

Purpose The aim of this study is to compare the effect of Ex-PRESS minishunt versus standard trabeculectomy on corneal endothelial cell count (ECC) in cases of primary open-angle glaucoma. Setting This comparative prospective nonrandomized study was conducted at Mansoura Ophthalmic Center, Mansoura University, Mansoura, Egypt. Patients and methods The study included 36 eyes of 25 patients with uncontrolled primary open-angle glaucoma. Nineteen eyes had Ex-PRESS glaucoma minishunt and 17 eyes had trabeculectomy. Specular microscopy was used to measure ECC using TOMEY EM-3000. ECC was measured preoperatively and compared with postoperative values at 6 and 12 months. Results The mean endothelial cell density was 2493.2±246.8 cells/mm2 before the surgery in the Ex-PRESS group and 2473.8±259.8 cells/mm2 in the trabeculectomy group (P=0.82). This value decreased significantly in both groups at 12 months postoperatively to 2348.1±309.5 in the Ex-PRESS group and 2276.1±342.4 in the trabeculectomy group. ECC loss at 1 year was less in the Ex-PRESS group at 5.7 versus 8% in the trabeculectomy group (P=0.051). Conclusion Ex-PRESS minishunt is considered a safe procedure regarding corneal endothelium, showing less decrease in ECC than conventional trabeculectomy.

Purpose: We investigated the factors influencing the morphology of filtration blebs after Ex-PRESS® surgery. We analyzed the thickness of the bleb wall and the height and the volume of blebs. Methods: This was a retrospective non-randomized study. After excluding patients who had undergone an additional glaucoma surgery, we analyzed the cases of 145 consecutive patients (180 eyes) who underwent trabeculectomy with Ex-PRESS® for the first time at Toyama University Hospital and were followed for >1 year. We used anterior segment optical coherence tomography to analyze the morphology of the blebs after Ex-PRESS surgery. We also examined potential influencing factors including age, central corneal thickness, type of glaucoma (primary open-angle glaucoma [POAG] or pseudo-exfoliation glaucoma [PEXG]), preoperative intraocular pressure (IOP), postoperative IOP, history of trabeculotomy, and operation method: Ex-PRESS surgery only, or simultaneous cataract surgery. Results: Ex-PRESS surgeries significantly decreased the IOP from 24.5 ± 8.8 mmHg to 11.1 ± 3.4 mmHg after 1 year (P < 0.001). The cases with higher blebs, larger volume of blebs, and thinner bleb wall had better surgical outcomes. Conclusion: Advanced age, higher postoperative IOP, PEXG, and simultaneous cataract surgeries were found to decrease the volume and height of blebs. Younger age, higher postoperative IOP, POAG, and simultaneous cataract surgeries were found to thicken the wall of blebs. Among the younger patients, there were many cases in which surgery was unsuccessful in spite the large volume of blebs. The reason for this may be that the wall of the bleb is thick.

Purpose: To compare surgical outcomes between Ex-Press® (EXP) and Baerveldt glaucoma implant (BGI) surgeries for primary open-angle glaucoma (POAG) and pseudo-exfoliation glaucoma (PEXG) patients. Patients and methods: This was a retrospective single-facility study. The inclusion criteria were that the patient's preoperative intraocular pressure (IOP) was > 21 mmHg and the post-surgery follow-up was > 1 year. We recruited 161 patients who had undergone a trabeculectomy with EXP (89 eyes) or BGI surgery (72 eyes). We compared these groups' postoperative IOP values and postoperative glaucoma medications, the reduction rate of corneal endothelial cell density (ECD), surgical outcomes, complications, the hospital stay duration, and the number of visits within 3 months post-surgery. Results: Both the EXP and BGI surgeries could significantly decrease the IOP. When the surgical success was defined postoperative IOP ≤ 21 mmHg, the surgical outcome of BGI was significantly better than EXP (p = 0.0148). When the surgical success was defined postoperative IOP ≤ 18, 15 , and 12 mmHg, the surgical outcomes between BGI and EXP surgeries were not significantly different (p = 0.0815, p = 0.331, and p = 0.910). The mean ECD reduction rate was significantly faster in the EXP group. The BGI patients had significantly shorter stays in the hospital and fewer visits within 3 months post-surgery (p < 0.0001). Conclusions: BGI surgery could provide comparable surgical outcomes as EXP surgery for POAG or PEXG patients with high preoperative IOP. BGI surgery has some advantages: fewer post-surgery visits, less postoperative interventions, and a lower ECD reduction rate. [ABSTRACT FROM AUTHOR]

RESUMEN La cirugía filtrante es una opción de tratamiento encaminada a disminuir la presión intraocular una vez que no hay respuesta a las alternativas no quirúrgicas. En los últimos años ha experimentado una evolución sorprendente. Aparecen nuevos dispositivos que buscan obtener un control tensional con las mínimas complicaciones; entre estos, el implante Ex-PRESS ha demostrado una efectividad similar a la trabeculectomía, mientras que la variante técnica para su implantación, descrita por Richard Hoffmann, posibilita excelentes resultados con menos dificultades. Se presenta un paciente masculino de 51 años de edad, de raza blanca, con antecedente de glaucoma, con agudeza visual mejor corregida de 100 VAR y presión intraocular de 32 mmHg. Se realizó implante de dispositivo Ex-PRESS (modelo P-50) mediante la técnica modificada de Richard Hoffmann, asociada al uso de mitomicina C al 0,2 % en el transoperatorio. A los dos años se lograron tensiones oculares de 17 mmHg y agudeza visual mejor corregida de 100 VAR.

Naoki Tojo, Atsushi Hayashi, Mitsuya Otsuka Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan Purpose: The aim of this study was to investigate the factors influencing the volume of the filtration bleb after Ex-PRESS® surgery.Methods: This was a retrospective non-randomized study. After excluding patients who had undergone an additional glaucoma surgery, 99 glaucoma patients who underwent Ex-PRESS® surgeries and were followed up for >2 years were analyzed. We used anterior segment optical coherence tomography to measure the bleb volume, and compared the volume at 1 year with that at 2 years after surgery. We also examined potential influencing factors, including age, number of medications, central corneal thickness, type of glaucoma, preoperative intraocular pressure (IOP), postoperative IOP, reduction ratio of IOP, history of trabeculotomy, and operation method (Ex-PRESS® surgery only or simultaneous cataract surgery).Results: Ex-PRESS® surgeries significantly decreased the IOP from 26.3±9.7 mmHg to 11.6±3.7 mmHg after 24 months (P

Abstract Background To compare trabeculectomy and EX-PRESS device implantation procedures for treating glaucoma and evaluate changes in corneal endothelial cell density (CECD). Methods This study prospectively evaluated changes in the CECD in 60 eyes of 60 patients who underwent trabeculectomy and 50 eyes of 45 patients who underwent EX-PRESS device implantation. Baseline patient data recorded included age at surgery, sex, type of glaucoma medications, and lens status. Using a noncontact specular microscope, corneal specular microscopy was performed preoperatively at the central cornea and then at 6, 12, 18 and 24 months after surgery. CECD before and after surgery was compared using a paired t-test. Results There was a significant decrease in the IOP and number of antiglaucoma medications in both groups after the surgery. The mean CECD in the trabeculectomy group was 2505 ± 280 cells/mm2 at baseline, while it was 2398 ± 274 cells/mm2 (P

Naoki Tojo, Mitsuya Otsuka, Atsushi Hayashi Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan Purpose: To compare the postoperative interventions and outcomes between conventional trabeculectomy and trabeculectomy with the Ex-PRESS® mini-glaucoma shunt device (Ex-Press).Methods: This was a retrospective, comparative, single-facility study. We analyzed the cases of 108 glaucoma patients who underwent trabeculectomy and were followed for >1 year. Thirty-nine eyes underwent a conventional trabeculectomy (conventional group) and 69 eyes underwent a trabeculectomy with an Ex-Press (Ex-Press group). As evaluation items, we examined postoperative intraocular pressure (IOP), the surgical success rate, postoperative complications, the number of days to laser suture lysis, and needling.Results: Trabeculectomy significantly decreased the patients’ IOP values from 27.8±7.9 to 11.1±3.9 mmHg in the conventional group (p

AIM:To investigate the efficacy of Bevacizumab intravitreal injection combined with EX-PRESS in the treatment of refractory glaucoma. METHODS: The research objects were 150 cases(150 eyes)of patients with refractory glaucoma from June 2014 to December 2016 in our hospital. All patients were treated with EX-PRESS glaucoma drainage device implantation, and their medicine data were analyzed retrospectively. Totally 70 cases(70 eyes)were treated with EX-PRESS only were set as the control group; 80 cases(80 eyes)received bevacizumab intravitreal injection on the basis of the treatment of the control group were set as the observation group. The successful rate of operation was evaluated, the intraocular pressure was measured before operation and at 7d, 1, 3, 6mo after treatment by non-contact conometer, followed by record of the visual acuity and complications before and after 6mo of treatment. RESULTS: The observation group's total surgical success rate was 72.5%, which was sharply higher than that of the control group(58.6%); while the partial success rate was 17.5%, which was significantly lower than that of the control group(30.0%), with statistical significance(χ2=5.453, P=0.028; χ2=4.213, P=0.047). Two groups' surgical failure rate had no distinct difference(χ2=0.000, P=1.000). There was no significant difference in visual acuity of the two groups before and after operation(P>0.05). There was no significant difference in intraocular pressure between the two groups(Fgroups=982.27, PFtime=941.88, PPP>0.05). The observation group's low intraocular pressure, anterior chamber bleeding and shallow anterior chamber incidence were significantly lower than those of the control group, there was statistical meaning(PCONCLUSION: Intravitreal injection of bevacizumab combined with EX-PRESS in the treatment of refractory glaucoma can improve the complete success rate, as well as perform effective control on complications such as short-term intraocular pressure, hyphema, low intraocular pressure.

Purpose: We investigated the factors that influence the reduction in corneal endothelial cells after Ex-Press® surgery. Methods: This was a retrospective study. We included patients who had undergone Ex-Press surgery and were followed up for > 2. We analyzed the corneal endothelial cell density (ECD) before and after Ex-Press surgery. We investigated the insertion position (Ex-Press device was inserted into cornea or trabecular meshwork (TM)), Ex-Press–iris touch, cornea–iris touch, peripheral anterior synechiae, history of trabeculotomy, history of selective laser trabeculoplasty, type of glaucoma, and simultaneous cataract surgery as influencing factors. We used multivariate analysis to determine the factors influencing the reduction rate of ECD. Results: We included 129 eyes. The mean of ECD had decreased 7.0% at 2 years. Ex-Press surgeries significantly decreased the ECD after 2 years (p = 0.0118). As a result of the multivariate analysis, the factor that led to a significantly faster reduction in ECD was the insertion position of the Ex-Press (p < 0.0001). The reduction rate of ECD after 2 years in cases of insertion into the cornea (27 eyes) was 15.1 ± 3.6%, and in cases of insertion into a TM (102 eyes), it was 5.2 ± 1.4%. Conclusions: Insertion into the cornea was a risk factor for rapid ECD loss. The Ex-Press should be inserted into a TM for long-term protection of the corneal endothelial cells. [ABSTRACT FROM AUTHOR]

Yoichiro Shinohara, Hideo Akiyama, Mikiya Magori, Shoji Kishi Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan Background: The purpose of this study was to investigate postoperative clinical outcomes in patients with neovascular glaucoma (NVG) who underwent trabeculectomy or EX-PRESS implantation and to identify predictors of successful EX-PRESS implantation. Methods: The study designed as a retrospective observational analysis and was set in a single tertiary center. Eighty-nine patients (89 eyes) with NVG, were treated using trabeculectomy alone (Trab group; n=39) or EX-PRESS implantation (EX group; n=50). All patients with a history of glaucoma surgery were excluded. The main outcome measures were postoperative intraocular pressure (IOP), visual acuity (VA), number of medications, complications, additional therapy, and success rate. Results: The mean follow-up duration was 4.6 months in the Trab group and 4.2 months in the EX group. There was no significant difference in IOP between the groups except at 1-month follow-up (P=0.045). The number of patients with early postoperative hypotony, a shallow anterior chamber, hyphema, or anterior chamber irrigation was significantly lower in the EX group than in the Trab group (P=0.016, 0.008, 0.019, and 0.014, respectively). The other outcomes, ie, VA, number of medications, and success rate, were similar between the two groups. In the EX group, the success rate was significantly lower in 15 patients with a history of vitrectomy compared to that in 35 patients without a history of vitrectomy (P=0.047). Conclusion: Implantation of an EX-PRESS device may be more effective and safer than trabeculectomy alone in patients with NVG. However, a history of vitrectomy may affect the surgical success rate when using EX-PRESS. Keywords: trabeculectomy, EX-PRESS, neovascular glaucoma, surgery, tube shunt

AIM: To evaluate intraocular pressure(IOP)control and visual rehabilitation after placement of the Ex-press® miniature glaucoma shunt with adjunctive amniotic membrane transplantation(AMT)and mitomycin C(MMC)in patients with post-traumatic open-angle glaucoma during 2y of follow up.METHODS: This was an interventional, 2-year, observational study. Eighteen eyes were prospectively observed(in 18 patients with traumatic secondary open-angle glaucoma)in which Ex-press miniature glaucoma filtration shunts were implanted with AMT and MMC. The outcome measures included intraocular pressure(IOP), best corrected visual acuity(BCVA), number of antiglaucoma medications, and complications. The progress of all patients was monitored for 24mo.RESULTS: Complete success(IOP CONCLUSION: The Ex-press miniature glaucoma filtration shunt with adjunctive AMT and MMC is effective and safe in cases of traumatic open-angle glaucoma. Surgical management is an appropriate surgical treatment in this series of cases.

Anita Lyssek-Boroń,1 Adam Wylęgała,1 Dariusz Dobrowolski,1,2 Ewelina Kowalczyk,1 Katarzyna Polanowska,1 Edward Wylęgała1,2 1Department of Ophthalmology with Pediatric Unit, Trauma Center, Santa Barbara Hospital, Sosnowiec, 2Department of Ophthalmology, Ophthalmology Clinic, Medical University of Silesia, District Railway Hospital, Katowice, Poland Purpose: The most frequent qualifications for pars plana vitrectomy (PPV) in diabetic patients include recurrent hemorrhage into the vitreous body chamber and vitreoretinal proliferation, also with traction retinal detachment. The aim of this study was to evaluate the effectiveness of EX-PRESS implant for the treatment of secondary glaucoma in elderly diabetic patients following PPV 23G with silicon oil or SF6 gas endotamponade.Materials and methods: This retrospective analysis comprised 18 patients (19 eyes). We applied EX-PRESS implants in 9 patients with neovascular glaucoma (NVG) and in 10 patients with non-NVG. All patients had earlier history of diabetes and vitrectomy 23G for diabetic complications. Intraocular pressure (IOP) was measured and compared before; 7 days; 1, 3, 6, and 12 months; and a year after the surgery.Results: Application of the implant exhibited a lowering effect on IOP. After 1 month, 53% of patients had IOP values beyond 22 mmHg, while 86% after 1 year.Conclusion: The implant can be used to treat both NVG and non-NVG in diabetic patients following PPV. Keywords: PPV, glaucoma surgery, DM, IOP

Purpose: We investigated the factors influencing the morphology of filtration blebs after Ex-PRESS® surgery. We analyzed the thickness of the bleb wall and the height and the volume of blebs.Methods: This was a retrospective non-randomized study. After excluding patients who had undergone an additional glaucoma surgery, we analyzed the cases of 145 consecutive patients (180 eyes) who underwent trabeculectomy with Ex-PRESS® for the first time at Toyama University Hospital and were followed for >1 year. We used anterior segment optical coherence tomography to analyze the morphology of the blebs after Ex-PRESS surgery. We also examined potential influencing factors including age, central corneal thickness, type of glaucoma (primary open-angle glaucoma [POAG] or pseudo-exfoliation glaucoma [PEXG]), preoperative intraocular pressure (IOP), postoperative IOP, history of trabeculotomy, and operation method: Ex-PRESS surgery only, or simultaneous cataract surgery.Results: Ex-PRESS surgeries significantly decreased the IOP from 24.5 ± 8.8 mmHg to 11.1 ± 3.4 mmHg after 1 year (P < 0.001). The cases with higher blebs, larger volume of blebs, and thinner bleb wall had better surgical outcomes.Conclusion: Advanced age, higher postoperative IOP, PEXG, and simultaneous cataract surgeries were found to decrease the volume and height of blebs. Younger age, higher postoperative IOP, POAG, and simultaneous cataract surgeries were found to thicken the wall of blebs. Among the younger patients, there were many cases in which surgery was unsuccessful in spite the large volume of blebs. The reason for this may be that the wall of the bleb is thick. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study is to compare the effect of Ex-PRESS minishunt versus standard trabeculectomy on corneal endothelial cell count (ECC) in cases of primary open-angle glaucoma. Setting This comparative prospective nonrandomized study was conducted at Mansoura Ophthalmic Center, Mansoura University, Mansoura, Egypt. Patients and methods The study included 36 eyes of 25 patients with uncontrolled primary open-angle glaucoma. Nineteen eyes had Ex-PRESS glaucoma minishunt and 17 eyes had trabeculectomy. Specular microscopy was used to measure ECC using TOMEY EM-3000. ECC was measured preoperatively and compared with postoperative values at 6 and 12 months. Results The mean endothelial cell density was 2493.2±246.8 cells/mm2 before the surgery in the Ex-PRESS group and 2473.8±259.8 cells/mm2 in the trabeculectomy group (P=0.82). This value decreased significantly in both groups at 12 months postoperatively to 2348.1±309.5 in the Ex-PRESS group and 2276.1±342.4 in the trabeculectomy group. ECC loss at 1 year was less in the Ex-PRESS group at 5.7 versus 8% in the trabeculectomy group (P=0.051). Conclusion Ex-PRESS minishunt is considered a safe procedure regarding corneal endothelium, showing less decrease in ECC than conventional trabeculectomy. [ABSTRACT FROM AUTHOR]

The purpose of the study was to compare the efficacy of Ex-Press and Ahmed drainage devices for the secondary neo-vascular glaucoma (NVG) in patients with diabetes mellitus. We observed 25 patients (25 eyes) with secondary NVG in the setting of proliferative diabetic retinopathy. The first group consisted of 10 patients (10 eyes) who underwent Ex-Press drainage implantation. The second group consisted of 15 patients (15 eyes) who were implanted Ahmed valve FP7 model. As a result the maximum value of 1OP in the analyzed groups decreased by 66.8 % and 64.2 % respectively immediately after the surgery. By the end of 18 months follow-up period, the absolute hypotensive effect in patients of group 1 was 20 % (2/10) whereas in group 2 - 60 % (9/15). Normal intraocular tension during treatment with glaucoma medications established in 30 % of cases in group 1 (3/10) and in 80 % of patients in group 2 (12/15). Thus, the use of Ex-Press drainage device for secondary NVG in patients with diabetes was ineffective in 70 % of cases. We can recommend choosing implantation of Ahmed valve for secondary NVG in patients with diabetes mellitus as the number of unsuccessful outcomes using Ahmed valve was observed only in 20 % of cases.

The article provides the review of domestic and foreign literature on the use of the Ex-Press drainage device in patients with refractory and primary open-angle glaucoma. We conducted a detailed analysis of hypotensive effectiveness of Ex-Press implantation combined with anti-VEGF drugs, antimetabolites (5-Fluorouracil, Mitomycin C), Glautex and Ologen drainages. We described the results of drainage device usage for neovascular, aphakic, pseudophakic glaucoma. We determined indications, modified methods of Ex-Press implantation and best options of combinations with drainages; established safe conditions of magnetic resonance imaging in patients with the implanted device. We presented all possible complications both in the early and late postoperative period. The influence of Ex-Press on endothelial layer of the cornea in dynamics was shown. Оп the basis of literature review it can be noted that Ex-press drainage device has proved to have a long hypotensive effect in patients with PОAG and pseudophakia. Whereas in refractory glaucoma it requires a combination with drainage and anti-metabolites. Implantation of Ex-press requires dynamic monitoring of patients due to the risk of long-term postoperative complications.

AIM: To evaluate the efficacy and safety of glaucoma drainage device Ex-PRESS® P-50 for combined cataract surgery and glaucoma. METHODS: Patients having cataract and open angle glaucoma or patients with open advanced glaucoma which needed two or more antiglaucoma medications were included. Combined cataract surgery and glaucoma with Ex-PRESS® P-50 model placed under scleral flap was performed. RESULTS: Out of 40 eyes of 40 patients (55% male and 45% female) completed the study during one-year follow-up. The mean of age was 76.6±11.02y. The intraocular pressure (IOP) decreased significantly during the 12-month follow-up from 23.5 mm Hg to 16.8 mm Hg (Wilcoxon signed ranks test, P

María Elena Mendoza-Mendieta,1 Ana Paola López-Venegas,2 Gerardo Valdés-Casas3 1Department of Anterior Segment, Dr Luis Sánchez Bulnes Hospital, Association to Prevent Blindness, Mexico City, Mexico; 2Institute of Ophthalmology, Conde de Valenciana, Mexico City, Mexico; 3Department of General Ophthalmology, Institute of Ophthalmology, Conde de Valenciana, Mexico City, Mexico Purpose: To evaluate the EX-PRESS P-50 implant compared to standard trabeculectomy (TBC). Methods: Single-center prospective randomized study; 20 eyes of 20 patients were treated with the EX-PRESS P-50 implant, and 20 eyes of 20 patients with TBC, over a 19-month period. Records of all patients were reviewed and compared. Success was defined as intraocular pressure (IOP) 5 mmHg or a decrease of 30% of IOP. Failure was defined as >21 mmHg or decline in visual acuity. Statistical analysis was made with Student’s t-test and χ2 test analyzed with SPSS version 13.0. Results: The average follow-up was 8.6 months (±4.9 months) for the EX-PRESS P-50 group and 9.6 months (±5.3 months) for the TBC group. The postoperative visual acuity and IOP were not significantly different. We report more complications in the EX-PRESS P-50 group. At 3, 6, and 12 months follow-up, the control group was found to be free of complications, whereas multiple complications were observed in the EX-PRESS P-50 group at 3 and 6 months follow-up. We found no differences in either group with respect to success. Conclusion: Both procedures are equally effective for the treatment of glaucoma, with 80% success in the EX-PRESS P-50 group and 72.7% in the control group. Keywords: glaucoma, IOP, EX-PRESS, trabeculectomy

Purpose. To investigate the morphogenesis of the aqueous humor (AH) outflow pathways and to assess the hypotensive effect of the modified implantation of Ex-PRESS mini-shunt.Material and methods. There were made 47 implantations of mini-shunts: in 10 cases – by the original technology, in 37 cases – by the modified one. The postoperative follow-up was 12-24 months. Pentacam examination allows excluding the contact of mini-shunt with the structures of anterior chamber angle. The assessment of the morphogenesis of the aqueous outflow pathways, the cause of IOP decompensation and the duration of hypotensive effect were defined during the ultrabiomicroscopic monitoring (UBM).Results. For the purpose of the stable and independent location of Ex-PRESS drainage it is advisable: for the discission of sclera to use the 30G needle directed at an angle of 30-50 against the iris surface; for the increase of the volume of intrascleral cavity – to cut out the scleral groove. The proposed nuances of the modified implantation exclude a hyper-filtration, a drainage dislocation and a tendency to scarring in the early postoperative period. In case of the adequate formed aqueous outflow pathways (n=38) the IOP level (Pt) was 14±3mmHg at first 24 hours, up to 6 months it was 19±3mmHg, and it was stable during the entire follow-up. After Ex-PRESS shunting the height of intrascleral cavity was 0.15-0.199mm, the scan height was 2.2±0.43mm in the adequate formed aqueous outflow pathways. The UBM data revealed that the aqueous outflow pathways were adequately formed in 28 cases, in 10 cases (21.3%) the transpebral massage was additionally administered, in 7 (14.9%) cases – the aqueous outflow pathways were partially sclerous, the additional hypotensive therapy was prescribed, in 2 (4.2%) cases the aqueous outflow pathways were failed.Conclusion. The indications for the Ex-PRESS implantation are an initially wide profile (430-450 and more) of the open anterior chamber angle or a previously performed laser iridectomy in case of the narrow anterior chamber angle. The creation of «unclosing» inner fistula is an undoubted advantage of Ex-PRESS implantation. The research of the morphogenesis of the aqueous outflow pathways after Ex-PRESS implantation in uncomplicated cases has revealed a formation of the classic filtering bleb in spite of an insignificant height of intrascleral channel. The cause of a failure of the hypotensive effect of the modified implantation of Ex-PRESS mini-shunt is an inadequate inflammatory reaction in the zone of intrascleral channel or bleb.

The EX-PRESS glaucoma filtration device appears to be an effective addition to our options to treat refractory glaucoma. The possibility to create a sclerostomy without tissue excision provides a safe and reliable outflow pathway for aqueous that is standard in size, reducing much of the variability associated with a surgical procedure. Prospective randomized studies comparing EX-PRESS implantation with trabeculectomy show encouraging results. However, complications usually encountered in filtration surgery have been reported, and EX-PRESS implantation can also lead to specific device-related complications. This article reviews the most common complications associated with this procedure.

AIM:To analyze the features of the filtering blebs following implantation of the Ex-PRESS glaucoma device (model P-50) with the aid of the Visante anterior segment optical coherence tomography (AS-OCT)METHODS: Five patients with open angle glaucomas were included in the study. They all underwent implantation of the Ex-PRESS device under a scleral flap. The surgical procedure was augmented with the use of mitomycin C subconjunctivally. The filtering blebs were analyzed with the Visante AS-OCT with the scans taken along the axis of the implantation of the glaucoma device.RESULTS: All filtering blebs were graded as diffuse functioning. The morphological characteristics of the blebs were similar to those of the trabeculectomy. However the use of the Ex-PRESS implant tend to form a characteristic episcleral lake at the site of the plate of the implant.CONCLUSION: The use of the Ex-PRESS implant produces filtering blebs similar to those of the trabeculectomy with the formation of a characteristic episcleral lake at the site of the plate of the implant.

Secondary epiretinal membranes (ERMs) can develop from various causes, including those associated with glaucoma treatments such as trabeculectomy (TLE) and EX-PRESS (EXP) insertion surgery. This study aimed to investigate the occurrence of new ERMs and changes in preexisting ERMs following TLE or EXP insertion. Between April 2018 and March 2019, 102 and 74 eyes that underwent primary and standalone TLE and EXP insertion, respectively, were evaluated. Of these, 48 eyes were included in the TLE group and 32 eyes were included in the EXP group. Optical coherence tomography (OCT) was used to assess preoperative and postoperative ERMs. In the TLE group, postoperative ERMs were observed in one (case 1) (3%) out of 34 eyes without preexisting ERMs and in one (case 2) (7%) out of 14 eyes with preexisting ERMs, showing an increase in ERM stage. In the EXP group, postoperative ERMs were observed in one (case 3) (5%) out of 22 eyes without preexisting ERMs and in one (case 4) (10%) out of 10 eyes with preexisting ERMs, showing a decrease in the ERM stage. Case 1 was a 58-year-old man with primary open-angle glaucoma (POAG) in the left eye who underwent TLE. Although no preoperative ERMs were observed, postoperative ERM was noted at the three-month follow-up. Case 2 was a 49-year-old man with POAG in the right eye who underwent TLE. Although ERM was observed preoperatively, ERM progressed at six months postoperatively. Case 3 was a 59-year-old woman with POAG in the right eye who underwent EXP insertion. No preoperative ERMs were observed, but an ERM was noted at the 15-month follow-up. Case 4 was a 72-year-old woman with steroid-induced glaucoma in the right eye who underwent EXP insertion surgery. A preoperative ERM was present, and the foveal pit was absent; however, the foveal pit was observed at the 12-month follow-up. Despite the low incidence of ERMs, filtration surgery may be associated with ERM development and the progression or regression of preexisting ERMs., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Aoki et al.)

Purpose: This study investigated postoperative visual acuity and corneal higher-order aberrations following EX-PRESS or trabeculectomy.Methods: Out of 56 eyes of 56 patients analyzed, 30 eyes were treated using trabeculectomy, while 26 eyes were treated with EX-PRESS. Visual acuity and corneal higher-order aberrations were analyzed in both groups before and at 2 weeks, 1, 2, and 3 months after the surgeries. Risk factors that could potentially influence corneal higher-order aberrations were evaluated.Results: Significant reductions in the IOP were observed at 3 months after the surgery in both groups. Although a significant decrease in the visual acuity (logMAR) was observed at 2 weeks after the surgery in both groups, at 1 month after the surgeries, there were no significant differences found for the vision as compared to the baseline. At each study visit in the trabeculectomy group, significantly higher corneal higher-order aberrations compared to baseline were noted. In the EX-PRESS group, however, these aberrations were no longer significantly different from the baseline at month 2 (P = 0.36). Analysis of the risk factors indicated that hypotony could influence corneal higher-order aberrations after surgery.Conclusions: Corneal higher-order aberrations were significantly increased at 1 month after EX-PRESS treatment, with levels returning to baseline by 2 months. After trabeculectomy, however, corneal higher-order aberrations remained significantly increased at 3 months after the procedure. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to investigate postoperative clinical outcomes in patients with neovascular glaucoma (NVG) who underwent trabeculectomy or EX-PRESS implantation and to identify predictors of successful EX-PRESS implantation. Methods: The study designed as a retrospective observational analysis and was set in a single tertiary center. Eighty-nine patients (89 eyes) with NVG, were treated using trabeculectomy alone (Trab group; n=39) or EX-PRESS implantation (EX group; n=50). All patients with a history of glaucoma surgery were excluded. The main outcome measures were postoperative intraocular pressure (IOP), visual acuity (VA), number of medications, complications, additional therapy, and success rate. Results: The mean follow-up duration was 4.6 months in the Trab group and 4.2 months in the EX group. There was no significant difference in IOP between the groups except at 1-month follow-up (P=0.045). The number of patients with early postoperative hypotony, a shallow anterior chamber, hyphema, or anterior chamber irrigation was significantly lower in the EX group than in the Trab group (P=0.016, 0.008, 0.019, and 0.014, respectively). The other outcomes, ie, VA, number of medications, and success rate, were similar between the two groups. In the EX group, the success rate was significantly lower in 15 patients with a history of vitrectomy compared to that in 35 patients without a history of vitrectomy (P=0.047). Conclusion: Implantation of an EX-PRESS device may be more effective and safer than trabeculectomy alone in patients with NVG. However, a history of vitrectomy may affect the surgical success rate when using EX-PRESS. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the outcomes of the Ex-PRESS Filtration Device in patients with uveitic glaucoma.Methods: We reviewed 23 eyes, comparing control simple glaucoma patients (n = 11) to uveitic glaucoma patients (n = 12). Intraocular pressure (IOP) and glaucoma medications at the preoperative examination were compared with those at the 6-month and 10-14-month postoperative examination. Surgical success was defined as ≥25% decrease in intraocular pressure without hypotony, and/or decrease in glaucoma medications at 6 months follow-up.Results: Statistically significant reduction in mean IOP from preoperative levels occurred in both groups at 6 months follow-up (p<0.0001) and 10-14 months follow-up (p = 0.0007) and in the mean number of medications in the uveitic glaucoma (UG) group (p = 0.0313).Conclusions: Surgical success was seen in 10 eyes in the control group (90.9%) and nine eyes (75%) in the UG group (p = 0.314). Ex-PRESS implantation is an effective surgical intervention for the management of uveitic glaucoma. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of filtering surgery using the EX-PRESS device on intraocular pressure (IOP), flare count, anterior chamber (AC) depth, and the corneal endothelium in primary open-angle glaucoma (POAG), including normal-tension glaucoma (NTG). Patients and methods: The study comprised 63 consecutive patients with POAG or NTG. They underwent complete ophthalmologic examinations, including measurement of visual acuity (VA), IOP, flare count, AC depth, and cell density of the corneal endothelium (CE). Two outcomes were used for surgical success: outcome 1 was defined as a ≥20% reduction in the IOP from the preoperative value, with an IOP ≥ 5 mmHg but ≤18 mmHg, and outcome 2 was defined as a ≥20% reduction in the IOP, with an IOP ≥ 5 mmHg but ≤15 mmHg. Results: The IOP significantly decreased from 17.7 preoperatively to 12.4 mmHg postoperatively ( P < 0.0001). The success rates for outcome 1 at 24 months were 81.3 and 46.7% for POAG and NTG, respectively ( P = 0.0065); the corresponding success rates for outcome 2 were 79.4 and 46.7% ( P = 0.0120). The flare count significantly increased on postoperative day 1 ( P = 0.0002) but recovered to insignificant levels by day 3 ( P = 0.0686). A transient decrease in AC depth was observed by 4 weeks after surgery ( P = 0.0017). The CE changed from 2529 preoperatively to 2428/mm at 24 months ( P = 0.0089). Conclusion: The advantage of filtering surgery using the EX-PRESS device includes reduced inflammation, and the disadvantages include loss of the CE and reduced effectiveness of NTG. [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose. To investigate the morphogenesis of the aqueous humor (AH) outflow pathways and to assess the hypotensive effect of the modified implantation of Ex-PRESS mini-shunt. Material and methods. There were made 47 implantations of mini-shunts: in 10 cases – by the original technology, in 37 cases – by the modified one. The postoperative follow-up was 12-24 months. Pentacam examination allows excluding the contact of mini-shunt with the structures of anterior chamber angle. The assessment of the morphogenesis of the aqueous outflow pathways, the cause of IOP decompensation and the duration of hypotensive effect were defined during the ultrabiomicroscopic monitoring (UBM). Results. For the purpose of the stable and independent location of Ex-PRESS drainage it is advisable: for the discission of sclera to use the 30G needle directed at an angle of 30-50 against the iris surface; for the increase of the volume of intrascleral cavity – to cut out the scleral groove. The proposed nuances of the modified implantation exclude a hyper-filtration, a drainage dislocation and a tendency to scarring in the early postoperative period. In case of the adequate formed aqueous outflow pathways (n=38) the IOP level (Pt) was 14±3mmHg at first 24 hours, up to 6 months it was 19±3mmHg, and it was stable during the entire follow-up. After Ex-PRESS shunting the height of intrascleral cavity was 0.15 – 0.199mm, the scan height was 2.2±0.43mm in the adequate formed aqueous outflow pathways. The UBM data revealed that the aqueous outflow pathways were adequately formed in 28 cases, in 10 cases (21.3%) the transpebral massage was additionally administered, in 7 (14.9%) cases – the aqueous outflow pathways were partially sclerous, the additional hypotensive therapy was prescribed, in 2 (4.2%) cases the aqueous outflow pathways were failed. Conclusion. The indications for the Ex-PRESS implantation are an initially wide profile (430-450 and more) of the open anterior chamber angle or a previously performed laser iridectomy in case of the narrow anterior chamber angle. The creation of «unclosing» inner fistula is an undoubted advantage of Ex-PRESS implantation. The research of the morphogenesis of the aqueous outflow pathways after Ex-PRESS implantation in uncomplicated cases has revealed a formation of the classic filtering bleb in spite of an insignificant height of intrascleral channel. The cause of a failure of the hypotensive effect of the modified implantation of Ex-PRESS mini-shunt is an inadequate inflammatory reaction in the zone of intrascleral channel or bleb.