Evaluation Of Shortdated Application Of Ex-PRESS In The Management Of Glaucoma

Objective:The aim of the study is to evaluate the therapeutic effects of the Ex-PRESS in the treatment of glaucoma.Methods:1 The primary open-angle glaucoma patients who had Ex-PRESS glaucoma shunt implantation( Ex-PRESS group, 15 cases 23 eyes)and who had trabeculectomy( trabeculectomy group, 16 cases 26 eyes) were collected in our hospital. Visual acuity( VA)、intraocular pressure( IOP)、postoperative complications、postoperative anti-glaucoma medications and the successful rate of the two groups were evaluated on 1 day、3day、1week、2week、1month、2month、3month and 6month post surgeries.A 20% reduction in IOP from the preoperative value or IOP between 5 to 20 mm Hg were defined as a success case.2 The complicated glaucoma treated with Ex-PRESS implantation(18 cases 20eyes)were enrolled in this study, including pigmentary, pseudoexfoliation syndrome,neovascular, uveitic, pseudophaki, traumatic,congenital and previous trabeculectomy.Visual acuity( VA)、intraocular pressure( IOP)、postoperative complications、postoperative anti-glaucoma medications and the successful rate were evaluated on 1day、3day、1week、2week、1month、2month、3month and 6month post surgeries.A 20% reduction in IOP from the preoperative value or IOP between 5 to 20 mm Hg were defined as a success case.Results:1 In the Ex-PRESS group, VA at 1day, 3day,1week and 2week post sugeries was significantly worse than baseline( p<0.05). By month 1,VA was back to baseline( p > 0.05) and remained nonsignificantly changed at subsequent visits up to 6months. In the trabeculectomy group,VA remained significantly worse than baseline at 1 day, 3day,1 week, 2week and 1 month post surgeries( p<0.05).By month 2,VA was no longer significantly different from baseline( p > 0.05). VA was not statistically different between the two groups at any time point( p>0.05). IOP was significantly reduced following surgery at each study visit( p < 0.05) in either Ex-PRESS group or trabeculectomy group. IOP was not statistically different between the two groups at each study visit after surgeries( p>0.05). There were no differences in successful rates between the two groups at 6 month. 3 eyes of the Ex-PRESS group presented with complications( shallow anterior chamber, tube obstruction and temporary high IOP). 12 eyes of the trabeculectomy group presented complications, including shallow anterior chamber( 6 eyes), hyphema( 4eyes), temporary high IOP( 1 eye) and bleb leakage( 1 eye). There was significant difference in the complications between the two groups.2 VA of the patients with complicated glaucoma treated with the Ex-PRESS glaucoma shunt implantation remained significantly worse than baseline at 1 day, 3day, 1 week, 2 week and 1 month( p<0.05) after surgery. By month 2, VA was no longer significantly different from baseline( p>0.05). IOP was significantly lower than baseline at each study visit( p<0.05). The incidence rate of the complications was 33%. The complications included shallow anterior chamber combined with choroidal detachment( 1 eye), shallow anterior chamber( 3 eyes), descemet membrane detachment( 1 eye) and hyphema( 1 eye). The rate of complete success 、qualified success and failure was 85%, 5% and 10%.Conclusions:The Ex-PRESS glaucoma shunt implantation was effective in the treatment of POAG and the complicated glaucoma.Although there was no significant difference in VA、 IOP 、 successful rate between the Ex-PRESS and trabeculectomy groups, it appeared that VA recovered faster in the Ex-PRESS group. In addition, the complications of the Ex-PRESS group were less than trabeculectomy group.