scholarly journals EX-PRESS Glaucoma Filtration Device: Management of Complications

Vision ◽  
2020 ◽  
Vol 4 (3) ◽  
pp. 39
Author(s):  
Michele Nicolai ◽  
Alessandro Franceschi ◽  
Paolo Pelliccioni ◽  
Vittorio Pirani ◽  
Cesare Mariotti
Keyword(s):  
Surgical Procedure ◽  
Refractory Glaucoma ◽  
Filtration Surgery ◽  
Device Management ◽  
Randomized Studies ◽  
Management Of Complications ◽  
Specific Device ◽  
Outflow Pathway ◽  
Glaucoma Filtration Device ◽  
Filtration Device

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.

Complications Specific To Ex-Press™ Shunts

2013 ◽  
Author(s):  
Steven R. Jr. Sarkisian ,
Keyword(s):  
Kansas City ◽  
The United States ◽  
External Diameter ◽  
Fort Worth ◽  
Filtration Surgery ◽  
Scleral Flap ◽  
Laser Trabeculoplasty ◽  
Topical Medications ◽  
Glaucoma Filtration Device ◽  
Filtration Device

The EX-PRESS™ Glaucoma Filtration Device (Alcon Laboratories, Inc., Fort Worth, Texas) has been commercially available in the United States since 2002 and was originally developed by Optonol, Inc. (Kansas City, Kansas) for implantation directly under the conjunctiva for an indication of control of intraocular pressure (IOP). It is a nonvalved, stainless steel device almost 3 mm long with an external diameter of approximately 400 microns and a 50 or 200 micron lumen, depending on the model. It has an external disc at one end and a spur-like extension on the other to prevent extrusion. The EX-PRESS™ shunt is one option for controlling IOP available to today’s glaucoma surgeon. The challenges and complications involved with EX-PRESS™ shunts are addressed below, as well as how to manage and prevent such scenarios. The original unguarded technique of implantation under the conjunctiva resulted in numerous complications, including hypotony, extrusion, and, most commonly, erosion of the implant. Typically, there was a period of hypotony followed by failure and erosion of the implant. Endophthalmitis has also been associated with an exposed implant. To avoid complications associated with subconjunctival implantation, Dahan and Carmichael proposed implanting the device under a scleral flap. This technique has greatly reduced erosions, and EX-PRESS™ shunts have been reported to have a lower rate of hypotony than trabeculectomy (15.8% with EX-PRESS™ shunt versus 22.5% in trabeculectomy). Since 2003, the manufacturer has recommended all users only implant the device under a scleral flap. Like all filtration surgery, failure is most commonly from episcleral and subconjunctival fibrosis. As with traditional filtration surgery, intraoperative adjunctive antimetabolites, such as mitomycin-C, may be used to limit the degree of postoperative scarring. However, should failure due to fibrosis occur, there are several options. The first is to add topical medications or perform laser trabeculoplasty. The second is to perform bleb revision or needling with an antifibrotic agent. Finally, as in a failed trabeculectomy, the surgeon may abandon the EX-PRESS™ shunt and perform a second unrelated procedure.

Advances in the Surgical Management of Glaucoma – The Role of the EX-PRESS® Glaucoma Filtration Device

2012 ◽  
Vol 06 (02) ◽  
pp. 83
Author(s):  
Robert Fechtner ◽  
Leo de Jong ◽  
Elie Dahan ◽  
Malik Kahook ◽  
Marlene Moster ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Glaucoma Surgery ◽  
Filtration Surgery ◽  
Medical Laser ◽  
Scleral Flap ◽  
New Evidence ◽  
Fine Tune ◽  
Glaucoma Filtration Device ◽  
Filtration Device

Clinicians aim to arrest the glaucomatous process by reducing intraocular pressure (IOP).1–5Available strategies include medical, laser and surgical techniques. Trabeculectomy is the traditional standard drainage surgery technique to achieve this. These MIGS techniques therefore appear to be adequate for patients whose glaucomatous damage is mild to moderate and whose target IOPs fall into this range. To achieve lower IOPs in patients with more advanced visual loss, efforts have simultaneously been made to fine-tune trabeculectomy. The use of the EX-PRESS® Glaucoma Filtration Device (Alcon) under a scleral flap is one such approach. How does the EX-PRESS Glaucoma Filtration Device benefit the conventional trabeculectomy procedure? What tips and tricks can contribute to its successful use? How safe is it? Is the additional cost to our health system justifiable? The satellite symposium ‘Advances in glaucoma surgery: new evidence in filtration surgery’, held at the 2011 World Glaucoma Congress, chaired by Dr Ivan Goldberg and sponsored by Alcon, set out to try to answer these questions.

scholarly journals Comparison between the Express Implant and Transscleral Diode Laser in Neovascular Glaucoma

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Faried Mohammed Wagdy ◽  
Adel Galal Zaky
Keyword(s):  
Previous History ◽  
Visual Outcome ◽  
Glaucoma Surgery ◽  
Neovascular Glaucoma ◽  
Panretinal Photocoagulation ◽  
History Of ◽  
Therapeutic Tools ◽  
Endothelial Growth Factor ◽  
Glaucoma Filtration Device ◽  
Filtration Device

Purpose. To compare the outcomes of Ex-PRESS glaucoma filtration device and transscleral cyclophotocoagulation (TSCP) in the management of neovascular glaucoma (NVG). Patients and Methods. A total of 30 eyes (12 express shunts and 18 TSCP) of 28 patients were included. The eyes had NVG with intraocular pressure (IOP) more than 21 mmHg of the maximally tolerated medication treatment after previous panretinal photocoagulation and antivascular endothelial growth factor (anti-VEGF) injection, with no previous history of a cyclodestruction procedure or glaucoma surgery, were randomized either for Ex-PRESS glaucoma filtration device or TSCP. The patients were followed up weekly for the first month and then monthly for 12 months as regard to the IOP, number of topical antiglaucoma drugs required, visual outcome, and postoperative complications. Results. IOP was successfully controlled with both techniques in 83.3% of the eyes. Both techniques had fewer complications and required fewer subsequent procedures. Conclusion. Both the Ex-PRESS glaucoma filtration device and TSCP might constitute safe and alternative therapeutic tools for patients with NVG. However, TSCP is an easier procedure, less time consuming, and does not require a learning curve.

scholarly journals PMD36 Cost-Effectiveness of the Ex-Press Glaucoma Filtration Device in the Netherlands

2011 ◽  
Vol 14 (7) ◽  
pp. A250 ◽  
Author(s):  
L. De jong ◽  
A. Lafuma ◽  
A.S. Aguade ◽  
O. Clément ◽  
G. Berdeaux
Keyword(s):  
Cost Effectiveness ◽  
The Netherlands ◽  
Glaucoma Filtration Device ◽  
Filtration Device

Flexible Ahmed Valve for Selected Cases of Refractory Glaucoma

2011 ◽  
Vol 22 (1) ◽  
pp. 83-89 ◽  
Author(s):  
Tharwat H. Mokbel ◽  
Mohamed A. Khalaf ◽  
Sherief E. El-Khouly ◽  
Nasser O. El-Metwally
Keyword(s):  
Flexible Plate ◽  
Ahmed Glaucoma Valve ◽  
Refractory Glaucoma ◽  
Filtration Surgery ◽  
Glaucoma Filtration Surgery ◽  
Ahmed Valve ◽  
History Of ◽  
Iop Measurement ◽  
Glaucoma Drainage Implants ◽  
Complete History

Purpose Glaucoma drainage implants are a useful alternative in treating glaucomas that are resistant to medical therapy and conventional glaucoma filtration surgery. The aim of this study is to evaluate flexible Ahmed glaucoma valve implant for selected cases of refractory glaucoma regarding its efficiency in controlling intraocular pressure (IOP) and possible postoperative complications of its implantation and their management. Method Patients included in this study were selected from patients with uncontrolled IOP by conventional filtration surgery as well as maximum tolerable topical medical treatment when surgery or laser is unlikely to control IOP. For every patient, complete history of age, sex, and history of previous ocular disease was done. Ocular examination for IOP measurement, best-corrected visual acuity measurement, and condition of conjunctiva was done. Ahmed glaucoma valve flexible plate implant (FP7 and FP8) was used. Results The present study included 40 eyes of 40 patients and preoperative IOP ranged from 32 mmHg to 58 mmHg with a mean of 40.36 ± 7.78 mmHg. The postoperative IOP ranged between 14.0 mmHg and 28.0 mmHg with a mean of 18.73 ± 4.8 mmHg. The criteria of success were applied in 37 eyes of 40 eyes (92.5%); they included 30 eyes (81.8%) with absolute success and 7 eyes (18.9%) with partial success. Conclusions Flexible Ahmed glaucoma valve plate implant is a satisfactory method for controlling elevated IOP in cases of refractory glaucoma with success rate of 92.5% and lower incidence of immediate postoperative and implant-related complications.

Advances in the Surgical Management of Glaucoma—The Role of the EX-PRESS® Glaucoma Filtration Device

2012 ◽  
Vol 05 (02) ◽  
pp. 81
Author(s):  
David W Cope ◽  
Robert Fechtner ◽  
Leo de Jong ◽  
Malik Kahook ◽  
Marlene Moster ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Surgical Techniques ◽  
Glaucoma Surgery ◽  
Medical Laser ◽  
Minimally Invasive Glaucoma Surgery ◽  
High Degree ◽  
Fine Tune ◽  
Glaucoma Filtration Device ◽  
Filtration Device

By reducing intraocular pressure (IOP), we aim to arrest the glaucomatous process. Our strategies include medical, laser, and surgical techniques. Trabeculectomy is the gold standard drainage surgery to achieve this; as there can be a high degree of variability in the procedure and its success depends on bleb creation, with the challenges of wound healing modulation, results remain unpredictable. Several devices are being assessed to try to achieve ‘minimally invasive glaucoma surgery’. While results will take some years to evaluate rigorously, it seems IOP levels by these means lie in the mid-teens. These minimally invasive glaucoma surgery techniques therefore would appear to be destined for patients whose glaucomatous damage is relatively mild to moderate and whose target IOPs fall into this range. To simultaneously achieve lower IOPs for patients with more advanced visual loss, efforts have been made to ‘fine-tune’ trabeculectomy. Use of the EX-PRESS® Glaucoma Filtration Device (GFD) under a scleral flap is one such approach. How does the EX-PRESS® GFD benefit the conventional trabeculectomy procedure? What tips and tricks contribute to its success? How safe is it? Is the additional cost to our health systems justifiable? This symposium, sponsored by Alcon, set out to try to answer these questions.

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