Long Term Results of the Ex-PRESS P-200 Miniature Glaucoma Filtration Device in Primary and Secondary Glaucoma

Maria Letizia Salvetat and Giorgio Beltrame

Department of Ophthalmology, Azienda per l’Assistenza Sanitaria 5 “Friuli Occidentale”, Pordenone, Italy

^*Correspondance to: Maria Letizia Salvetat 

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Abstract:

Purpose: To report the efficacy and safety of the Ex-PRESS P-200 glaucoma filtration device implanted under a partial-thickness scleral flap in white adult patients affected by uncontrolled primary or secondary glaucoma, and to evaluate the ability of clinical variables to predict the success of the Ex-PRESS implant.
Design: clinical, retrospective, non‐comparative case series study. Study Population: Chart review of patients of 18 to 90 years of age affected by uncontrolled glaucoma with intraocular pressure (IOP) ≥ 18 mmHg and ≤ 45 mmHg on maximum tolerated medical therapy, who had undergone implantation of the Ex‐PRESS P-200 miniature glaucoma shunt as first-line glaucoma filtration surgery, and had a minimum of 12-month postoperative follow up. Intervention: The Ex-PRESS P-200 device was implanted under a scleral flap pre-treated with Mitomycin C as a single procedure or combined with phacoemulsification cataract extraction and in the bag IOL implantation when necessary. Main Outcome Measures: IOP, number of anti-glaucoma drugs, intra- and post-operative complications. Success was defined as complete if postoperative IOP was 6 mmHg to 18 mmHg without medication, and qualified if IOP was within the same range with anti-glaucoma medication. Failure was defined as postoperative IOP <6 or >18 mmHg, prolonged hypotony or loss of light perception.
Results: A total of 132 eyes of 132 patients (mean age of 75.5 years ± 10 years) with a mean follow‐ up of 31.6 months ± 24 months (range: 12-96) were included in the study. Mean preoperative IOP and number of anti-glaucoma medications significantly decreased at all postoperative follow-ups (P<0.001), with a mean postoperative reduction of 42% and 59%, respectively (P<0.001). KaplanMeyer analysis determined a complete and qualified success rate of respectively 34% and 74% at 3 years after surgery. The most frequent postoperative complications included hypotony (10 eyes), hyphema (10 eyes) and flat anterior chamber (9 eyes). The best predictor of qualified success at 3-year follow-up was combined cataract extraction surgery (univariate Cox model; hazard ratio [HR] 3.2; P=0.001).
Conclusion: The Ex-PRESS P-200 implant is an effective IOP-lowering procedure in white adults affected by primary or secondary glaucoma, both alone and combined with cataract surgery. The best predictor of success of the Ex-PRESS P-200 implant was simultaneous cataract extraction surgery.

Keywords:

Ex-PRESS glaucoma filtration device; Glaucoma; Glaucoma filtration surgery; Intraocular pressure; Success rate; Risk factors

Cite the Article:

Salvetat ML, Beltrame G. Long Term Results of the Ex-PRESS P-200 Miniature Glaucoma Filtration Device in Primary and Secondary Glaucoma. World J Surg Surgical Res. 2018; 1: 1043.