Ex‐press glaucoma shunt for the treatment of complex glaucoma

Abstract Purpose To assess the safety and efficacy of Ex‐PRESS Mini glaucoma (EMG) shunt for the surgical treatment of complex glaucoma. Methods EMG shunt was inserted in the following cases of complex glaucoma: Failed glaucoma drainage surgery Multiple co‐morbidity /high risk (proliferative diabetic retinopathy,neovascular glaucoma, vitreo‐retinal surgery, OSD). Surgical procedure was in accordance with published methods. 10 cases of complex glaucoma were reviewed retrospectively over aperiod at least 6 months following surgery. The end‐points were: intraocular pressure (IOP) number of glaucoma drops used visual acuity Unqualified success was defined as IOP < 19 mmHg without glaucoma drops, and qualified success was IOP < 19 mmHg with the use of drops. Complications were noted. Results 7 cases (70%) were successful at a mean of 6 months post operatively without drops with a mean IOP of 11.6mmHg (sd 1.6mmHg). 3 cases required drops to achieve the target IOP, the mean IOP being 18.7mmHg (sd 0.8 mmHg) with a mean of 1.3 glaucoma medications required at 6 months post‐operatively. (3.7 pre‐op 1.3 post‐op, p<0.05) Cases requiring additional topical treatment had ocular co‐morbidity. Conclusion EMG shunt was safe and effective in controlling IOP in complex cases of glaucoma EMG shunt was relatively easy to insert with a minimum of post‐operative manipulations The IOP was stable and predictable at 6 months; the IOP was reduced significantly at 6 months (p<0.05) with a significant reduction in medications (p<0.05) Multiple co‐morbidities were associated with less chance of unqualified success Although a small cohort, the experience so far in treating complex cases with EMG shunt has been very encouraging and the study is continuing with more data being collected