Clinical Evaluation Of The Ex-PRESS Glaucoma Drainage Device Implantation For Treatment Of Refractory Glaucoma

Objective:To evaluate the efficacy of the Ex-PRESS glaucoma drainage device in treatment of refractory glaucoma.Methods:This was a prospective case-controlled study. Refractory glaucoma patients were collected in Tangshan City Eye Hospital form Jun2012to Oct2012. Fifty-eight patients (66eyes) were enrolled, who were divided into trial group (30cases,33eyes) and control group (28cases,33eyes) in random. The patients in trial group were implanted the Ex-PRESS glaucoma drainage device, but the counterparts were received trabeculectomy. Deep lamellar sclerectomy and adjustable suture were used in the both groups. The patients (3cases,3eyes) in control group were transferred to trial group for the Ex-PRESS glaucoma drainage device with the reason of their wish, and the other patients (4cases,5eyes) in trial group were transferred to control group with the reason of money.The intraocular pressure、the successful rate、filtering bleb、the ciliochoroidal low echogenic area and the anti-glaucoma medications were observed on the lth、7th day and1month、3month、6month.Results:The intraocular pressure (IOP) of22eyes were controlled in the normal range in trial group at the6month after surgery. Drainage pipe blocked by peripheral iris occurred in2eyes, one case was relieved by miosis of pilocarpine, the other was removed by surgery. The IOP of6eyes were controlled by less than one kind of anti-glaucoma medication. The total successful rate was84.8%. There were14eyes with normal IOP in control group, of which5eyes needed additional medication control. The total successful rate was57.6%. Malignant glaucoma occurred in one eye at1month and restored by medication. The IOP at different time after operation was lower than baseline, which reached the statistical significance (P<0.05). There was no statistical significance (p>0.05) between the two groups during1th、7th day after surgery, but it was significant from1month to6month. The amount of functional filtering bleb in trial group was higher than that in control group from3month and6month, which was statistically significant. However, the difference was not found before1month after operation. The occurrence of ciliochoroidal low echogenic area in trial group was lower than that in control group at1th and7th day, which had statistical significance, and they were all recovered to normal at1month. Hyphema occurred in4eyes in trial group and6eyes in control group respectively, and blood was absorbed spontaneously in1week. Transient elevated IOP was observed in4eyes in both groups during1week after surgery, and decreased to normal by medication and removal of adjustable suture. The onset of shallow anterior chamber in5eyes (15.2%) was higher than that in control group (8eyes,24.2%). In the5eyes,4eyes were combined with hypotony and1eye with grade III shallow anterior chamber. Similarly,5eyes were combined with hypotony and no grade III shallow anterior chamber occurred in control group.Conclusions:The Ex-PRESS glaucoma drainage device implantation was a simple, less invasive, comfortable, safe and effective method in treatment of refractory glaucoma. Drainage device implantation with adjustable suture can reduce the occurrence of shallow anterior chamber in the early period after surgery. Drainage device implantation with deep lamellar sclerectomy can reduce the filtering bleb scarring and decrease IOP effectively. It is important to prevent onset of shallow anterior chamber and blockage of drainage pipe after operation and to manage these complications properly.