Advertisement

Ex-PRESS Miniature Glaucoma Shunt for the Treatment of Uveitic Glaucomas

  • Evan AllanEmail author
  • Steven R. SarkisianJr.
Part of the Essentials in Ophthalmology book series (ESSENTIALS)

Abstract

The Ex-PRESS mini-glaucoma device is an alternative to traditional trabeculectomy. The device has been found to be safe, as efficacious and even superior to trabeculectomy in some aspects. For complex glaucomas, the Ex-PRESS should be considered as an alternative to glaucoma drainage implants. Winston Churchill once said, “Without tradition, art is a flock of sheep without a shepherd. Without innovation, it is a corpse.” Often in times of technological advance, progress requires a melding of tradition and innovation. Ophthalmology and glaucoma surgery are no different. Amidst a flood of minimally invasive glaucoma surgical advancements, filtration and shunt surgeries remain steadfast as definitive therapies for severe glaucoma. Trabeculectomy has remained the gold standard for glaucoma surgery; however, advances in surgical technique have even come to this decades-old procedure. The Ex-PRESS Mini-Glaucoma Device is now accepted in many circles as a modification of the trabeculectomy procedure available to many patients.

Keywords

Glaucoma Glaucoma surgery Trabeculectomy Ex-PRESS device Intraocular pressure 

Notes

Compliance with Ethical Requirements

Dr. Allen had no conflict of interest. Dr. Sarkisian is a consultant to Alcon. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Supplementary material

Video 9.1

Ex-PRESS Shunt Implantation; Steven R. Sarkisian, Jr., MD (MV4 204,075 kb)

References

  1. 1.
    Geffen N, Trope GE, Alasbali T, Salonen D, Crowley AP, Buys YM. Is the Ex-PRESS glaucoma shunt magnetic resonance imaging safe? J Glaucoma. 2010;19(2):116–8. doi: 10.1097/IJG.0b013e3181a98bda.PubMedGoogle Scholar
  2. 2.
    Nyska A, Glovinsky Y, Belkin M, Epstein Y. Biocompatibility of the Ex-PRESS miniature glaucoma drainage implant. J Glaucoma. 2003;12(3):275–80.CrossRefPubMedGoogle Scholar
  3. 3.
    Gandolfi S, Traverso CF, Bron A, Sellem E, Kaplan-Messas A, Belkin M. Short-term results of a miniature draining implant for glaucoma in combined surgery with phacoemulsification. Acta Ophthalmol Scand Suppl. 2002;236:66.CrossRefPubMedGoogle Scholar
  4. 4.
    Stewart RM, Diamond JG, Ashmore ED, Ayyala RS. Complications following ex-press glaucoma shunt implantation. Am J Ophthalmol. 2005;140(2):340–1. doi: 10.1016/j.ajo.2005.02.033.CrossRefPubMedGoogle Scholar
  5. 5.
    Traverso CE, De Feo F, Messas-Kaplan A, Denis P, Levartovsky S, Sellem E, Badala F, Zagorski Z, Bron A, Gandolfi S, Belkin M. Long term effect on IOP of a stainless steel glaucoma drainage implant (Ex-PRESS) in combined surgery with phacoemulsification. Br J Ophthalmol. 2005;89(4):425–9. doi: 10.1136/bjo.2004.058032.PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Wamsley S, Moster MR, Rai S, Alvim HS, Fontanarosa J. Results of the use of the Ex-PRESS miniature glaucoma implant in technically challenging, advanced glaucoma cases: a clinical pilot study. Am J Ophthalmol. 2004;138(6):1049–51. doi: 10.1016/j.ajo.2004.06.024.CrossRefPubMedGoogle Scholar
  7. 7.
    Dahan E, Carmichael TR. Implantation of a miniature glaucoma device under a scleral flap. J Glaucoma. 2005;14(2):98–102.CrossRefPubMedGoogle Scholar
  8. 8.
    Beltran-Agullo L, Trope GE, Jin Y, Wagschal LD, Jinapriya D, Buys YM. Comparison of visual recovery following Ex-PRESS versus trabeculectomy: results of a prospective randomized controlled trial. J Glaucoma. 2013. doi: 10.1097/IJG.0b013e31829e1b68.PubMedGoogle Scholar
  9. 9.
    Netland PA, Sarkisian Jr SR, Moster MR, Ahmed II, Condon G, Salim S, Sherwood MB, Siegfried CJ. Randomized, prospective, comparative trial of EX-PRESS glaucoma filtration device versus trabeculectomy (XVT study). Am J Ophthalmol. 2014;157(2):433–40. doi: 10.1016/j.ajo.2013.09.014. e433.CrossRefPubMedGoogle Scholar
  10. 10.
    Sugiyama T, Shibata M, Kojima S, Ueki M, Ikeda T. The first report on intermediate-term outcome of Ex-PRESS glaucoma filtration device implanted under scleral flap in Japanese patients. Clin Ophthalmol. 2011;5:1063–6. doi: 10.2147/OPTH.S23129.PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Dahan E, Ben Simon GJ, Lafuma A. Comparison of trabeculectomy and Ex-PRESS implantation in fellow eyes of the same patient: a prospective, randomised study. Eye (Lond). 2012;26(5):703–10. doi: 10.1038/eye.2012.13.CrossRefGoogle Scholar
  12. 12.
    Wang W, Zhou M, Huang W, Zhang X. Ex-PRESS implantation versus trabeculectomy in uncontrolled glaucoma: a meta-analysis. PLoS One. 2013;8(5):e63591. doi: 10.1371/journal.pone.0063591.PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Kanner EM, Netland PA, Sarkisian Jr SR, Du H. Ex-PRESS miniature glaucoma device implanted under a scleral flap alone or combined with phacoemulsification cataract surgery. J Glaucoma. 2009;18(6):488–91. doi: 10.1097/IJG.0b013e31818fb44e.CrossRefPubMedGoogle Scholar
  14. 14.
    Broadway DC, Bloom PA, Bunce C, Thiagarajan M, Khaw PT. Needle revision of failing and failed trabeculectomy blebs with adjunctive 5-fluorouracil: survival analysis. Ophthalmology. 2004;111(4):665–73. doi: 10.1016/j.ophtha.2003.07.009.CrossRefPubMedGoogle Scholar
  15. 15.
    Freidl KB, Moster MR. ExPRESS shunt surgery: preferred glaucoma surgery in residency training? Surv Ophthalmol. 2012;57(4):372–5. doi: 10.1016/j.survophthal.2012.02.008.CrossRefPubMedGoogle Scholar
  16. 16.
    de Jong LA. The Ex-PRESS glaucoma shunt versus trabeculectomy in open-angle glaucoma: a prospective randomized study. Adv Ther. 2009;26(3):336–45. doi: 10.1007/s12325-009-0017-6.CrossRefPubMedGoogle Scholar
  17. 17.
    de Jong L, Lafuma A, Aguade AS, Berdeaux G. Five-year extension of a clinical trial comparing the EX-PRESS glaucoma filtration device and trabeculectomy in primary open-angle glaucoma. Clin Ophthalmol. 2011;5:527–33. doi: 10.2147/OPTH.S18565.PubMedCentralPubMedGoogle Scholar
  18. 18.
    Moisseiev E, Zunz E, Tzur R, Kurtz S, Shemesh G. Standard trabeculectomy and Ex-PRESS miniature glaucoma shunt: a comparative study and literature review. J Glaucoma. 2014. doi: 10.1097/IJG.0000000000000047.Google Scholar
  19. 19.
    Wagschal LD, Trope GE, Jinapriya D, Jin YP, Buys YM. Prospective randomized study comparing Ex-PRESS to trabeculectomy: 1-year results. J Glaucoma. 2013. doi: 10.1097/IJG.0000000000000029.Google Scholar
  20. 20.
    Cunliffe IA, Dapling RB, West J, Longstaff S. A prospective study examining the changes in factors that affect visual acuity following trabeculectomy. Eye (Lond). 1992;6(Pt 6):618–22. doi:10.1038/eye.1992.133.CrossRefGoogle Scholar
  21. 21.
    Good TJ, Kahook MY. Assessment of bleb morphologic features and postoperative outcomes after Ex-PRESS drainage device implantation versus trabeculectomy. Am J Ophthalmol. 2011;151(3):507–13. doi: 10.1016/j.ajo.2010.09.004. e501.CrossRefPubMedGoogle Scholar
  22. 22.
    Maris Jr PJ, Ishida K, Netland PA. Comparison of trabeculectomy with Ex-PRESS miniature glaucoma device implanted under scleral flap. J Glaucoma. 2007;16(1):14–9. doi: 10.1097/01.ijg.0000243479.90403.cd.CrossRefPubMedGoogle Scholar
  23. 23.
    Seider MI, Rofagha S, Lin SC, Stamper RL. Resident-performed Ex-PRESS shunt implantation versus trabeculectomy. J Glaucoma. 2012;21(7):469–74. doi: 10.1097/IJG.0b013e3182182bfb.CrossRefPubMedGoogle Scholar
  24. 24.
    Chen G, Li W, Jiang F, Mao S, Tong Y. Ex-PRESS implantation versus trabeculectomy in open-angle glaucoma: a meta-analysis of randomized controlled clinical trials. PLoS One. 2014;9(1):e86045. doi: 10.1371/journal.pone.0086045.PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Carreno E, Villaron S, Portero A, Herreras JM, Maquet JA, Calonge M. Surgical outcomes of uveitic glaucoma. J ophthalmic inflamm infect. 2011;1(2):43–53. doi: 10.1007/s12348-010-0012-8.PubMedCentralCrossRefPubMedGoogle Scholar
  26. 26.
    Siddique SS, Suelves AM, Baheti U, Foster CS. Glaucoma and uveitis. Surv Ophthalmol. 2013;58(1):1–10. doi: 10.1016/j.survophthal.2012.04.006.CrossRefPubMedGoogle Scholar
  27. 27.
    Sung VC, Barton K. Management of inflammatory glaucomas. Curr Opin Ophthalmol. 2004;15(2):136–40.CrossRefPubMedGoogle Scholar
  28. 28.
    Ceballos EM, Beck AD, Lynn MJ. Trabeculectomy with antiproliferative agents in uveitic glaucoma. J Glaucoma. 2002;11(3):189–96.CrossRefPubMedGoogle Scholar
  29. 29.
    Kaburaki T, Koshino T, Kawashima H, Numaga J, Tomidokoro A, Shirato S, Araie M. Initial trabeculectomy with mitomycin C in eyes with uveitic glaucoma with inactive uveitis. Eye (Lond). 2009;23(7):1509–17. doi: 10.1038/eye.2009.117-cme.CrossRefGoogle Scholar
  30. 30.
    Kok H, Barton K. Uveitic glaucoma. Ophthalmol Clin North Am. 2002;15(3):375–87. viii.CrossRefPubMedGoogle Scholar
  31. 31.
    Moorthy RS, Mermoud A, Baerveldt G, Minckler DS, Lee PP, Rao NA. Glaucoma associated with uveitis. Surv Ophthalmol. 1997;41(5):361–94.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Dean McGee Eye InstituteOklahoma CityUSA

Personalised recommendations