Clinical Study Ex-PRESS Drainage In The Treatment Of Refractory Glaucoma

Objective: To investigate the effect of Ex-Press shunt in the treatment of refractory glaucoma.Methods: Twenty-five patients(26 eyes) with refractory glaucoma were recruited from The First Affiliated Hospital of Chongqing Medical University treated with Ex-Press shunt. P50 type shunt was used in 8 eyes and P200 type shunt was used in the others. The average intraocular pressure(IOP), visual acuity, postoperative IOP-lowering drug use and complications were recorded on 1 day, 2 days, 3 days, 1 week, 1 month, 3 months, 6 months after surgery, respectively. Statistical analysis was performed in SPSS 19.0 software, and the data were expressed as mean ± standard deviation. The level of significance adopted was P≤0.05.Results: The IOP of patients was in the range of 21~54mmHg, with a mean IOP of(39.93±6.36)mmHg before surgery. The IOP of patients was in the range of 7~21mmHg after 1 day, 2 days, 3 days, 1 week of surgery. The IOP was in the range of 11~29mmHg with a mean IOP of(15.95±3.63) mmHg after 1 month of surgery, and was significantly lower than that before surgery. The IOP was in the range of 10~30mmHg with a mean IOP of(16.96±3.58)mmHg after 3 month of surgery, and was significantly lower than that before surgery. The IOP was in the range of 11~33mmHg with a mean IOP of(17.30±3.31)mmHg after 6 month of surgery, and was significantly lower than that before surgery. Uncontrolled high IOP developed in 3 eyes, in which one was neovascular glaucoma, one was secondary glaucoma caused by uveitis, and the other was post-traumatic secondary glaucoma. The best corrected visual acuity(BCVA) improved in 8 eyes(32.00%), remained the same in 12 eyes(48.00%), reduced in 5 eyes(20.00%), and one eye lost follow-up after 1 month of surgery. The BCVA improved 6 eyes(24.00%), remained the same in 14 eyes(56.00%), reduced in 5 eyes(20.00%), and one eye lost follow-up after 3 months of surgery. After 6 months, The BCVA improved 6 eyes(30.00%), remained the same in 10 eyes(50.00%), reduced in 4 eyes(20.00%). Postoperative complications included shallow anterior chamber(7 eyes, 26.92%), hyphema(2 eyes, 7.69%), filtered scarring(6 eyes, 23.07%), recurrence of uveitis(1 eye, 3.85%). After 1 week of surgery, IOP was controlled in all the patient(26 eyes), and the success rate was 100%. After 1 month, the IOP of 24 eyes was controlled. The total success rate was 96.00%, of which the success rate of P50-type was 100%, and P200-type was 94.10%. After 3 months of surgery, the IOP of 22 eyes in the total of 25 eyes was controlled. The total success rate was 88.00%, of which the success rate of P50-type was 87.50%, and P200-type was 88.90%. After 6 months of surgery, the IOP of 17 eyes in the total of 20 eyes was controlled. The total success rate was 85.00%, of which the success rate of P50-type was 85.70%, and P200-type was 80%.CONCLUSION: Ex-Press shunt implantation significantly reduce intraocular pressure in patients with refractory glaucoma. As Ex-Press implantation is technically simple, with shorter operation time and fewer postoperative complications, it will be a useful addition to the surgical treatment of glaucoma.