Advertisement

Glaucoma Surgery with the Ex-Press Glaucoma Shunt

  • Lindsay A. McGrath
  • Graham A. LeeEmail author
  • Ivan Goldberg
Chapter

Abstract

Commercially available for over a decade, the Ex-Press miniature glaucoma shunt has been implanted in more than 75,000 eyes. This biocompatible device shunts aqueous from the anterior chamber to an intrascleral plane and then into a filtration bleb similar fashion to that of a trabeculectomy, but without the need for sclerectomy or iridectomy. This theoretically simplifies glaucoma filtration surgery and possibly offers a more consistent drainage operation for the general ophthalmologist. We review the surgical implantation of an Ex-Press device and summarize the clinical outcomes, complications, and potential limitations of this novel device.

Keywords

Anterior Chamber Glaucoma Surgery Anterior Segment Optical Coherence Tomography Glaucoma Medication Neovascular Glaucoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 18.1

In this 2-min video, Dr. Ike Ahmed demonstrates the insertion of the Ex-Press shunt (MPG 247224 kb)

References

  1. 1.
    Dahan E, de Smedt S, Garcia Feijoo J, et al. Minimally penetrating glaucoma surgery with the Ex-PRESS miniature shunt. In: Fine IH, Mojon D, editors. Minimally invasive ophthalmic surgery. Berlin: Springer; 2009. p. 172–82.Google Scholar
  2. 2.
    Sarkisian SR. The ex-press mini glaucoma shunt: technique and experience. Middle East Afr J Ophthalmol. 2009;16(3):134–7.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    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.e1.PubMedCrossRefGoogle Scholar
  4. 4.
    Sugiyama T, Shibata M, Kojima S, et al. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Traverso CE, De Feo F, Messas-Kaplan A, et al. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Estermann S, Yuttitham K, Chen JA, et al. Comparative in vitro flow study of 3 different Ex-PRESS miniature glaucoma device models. J Glaucoma. 2013;22(3):209–14.PubMedCrossRefGoogle Scholar
  7. 7.
    Hendrick AM, Kahook MY. Ex-PRESS mini glaucoma shunt: surgical technique and review of clinical experience. Expert Rev Med Devices. 2008;5(6):673–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Francis BA, Singh K, Lin SC, et al. Novel glaucoma procedures: a report by the American Academy of Ophthalmology. Ophthalmology. 2011;118(7):1466–80.PubMedGoogle Scholar
  9. 9.
    Seibold LK, Rorrer RA, Kahook MY. MRI of the Ex-PRESS stainless steel glaucoma drainage device. Br J Ophthalmol. 2011;95(2):251–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Nyska A, Glovinsky Y, Belkin M, Epstein Y. Biocompatibility of the Ex-PRESS miniature glaucoma drainage implant. J Glaucoma. 2003;12(3):275–80.PubMedCrossRefGoogle Scholar
  11. 11.
    Dahan E, Carmichael TR. Implantation of a miniature glaucoma device under a scleral flap. J Glaucoma. 2005;14(2):98–102.PubMedCrossRefGoogle Scholar
  12. 12.
    Salim S. Ex-PRESS glaucoma filtration device-surgical technique and outcomes. Int Ophthalmol Clin. 2011;51(3):83–94.PubMedCrossRefGoogle Scholar
  13. 13.
    Ex-press glaucoma filtration device: directions for use. Fort Worth: Alcon Laboratories, Inc. Manufacturer’s instructions (unpublished).Google Scholar
  14. 14.
    Aziz H, Fantes F, Dubovy S. Histopathology of the Ex-PRESS shunt. Ophthalmic Surg Lasers Imaging. 2011;42 Online:e94–6.PubMedGoogle Scholar
  15. 15.
    Wamsley S, Moster MR, Rai S, et al. 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.PubMedCrossRefGoogle Scholar
  16. 16.
    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.PubMedCrossRefGoogle Scholar
  17. 17.
    Lankaranian D, Razeghinejad MR, Prasad A, et al. Intermediate-term results of the Ex-PRESS miniature glaucoma implant under a scleral flap in previously operated eyes. Clin Experiment Ophthalmol. 2011;39(5):421–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Dahan E. Ex-Press miniature glaucoma implant. Expert Rev Ophthalmol. 2007;2(6):899–909.CrossRefGoogle Scholar
  19. 19.
    Bissig A, Feusier M, Mermoud A, Roy S. Deep sclerectomy with the Ex-PRESS X-200 implant for the surgical treatment of glaucoma. Int Ophthalmol. 2010;30(6):661–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Hammel N, Lusky M, Kaiserman I, et al. Changes in anterior segment parameters after insertion of Ex-PRESS miniature glaucoma implant. J Glaucoma. 2013;22(7):565–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Dahan E, Carmichael TR. The surgical treatment of neovascular glaucoma with a 200 micron miniature glaucoma shunt. In: The association for research in vision and ophthalmology. Fort Lauderdale: Invest Ophthalmol Vis Sci; 2005. p. 77.Google Scholar
  22. 22.
    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.PubMedCentralPubMedGoogle Scholar
  23. 23.
    Elgin U, Simsek T, Batman A. Use of the ex-press miniature glaucoma implant in a child with Sturge-Weber syndrome. J Pediatr Ophthalmol Strabismus. 2007;44(4):248–50.PubMedGoogle Scholar
  24. 24.
    Vetrugno M, Ferreri P, Sborgia C. Ex-PRESS miniature glaucoma device in vitrectomized eyes. Eur J Ophthalmol. 2010;20(5):945–7.PubMedGoogle Scholar
  25. 25.
    Ates H, Palamar M, Yagci A, Egrilmez S. Evaluation of Ex-PRESS mini glaucoma shunt implantation in refractory postpenetrating keratoplasty glaucoma. J Glaucoma. 2010;19(8):556–60.PubMedCrossRefGoogle Scholar
  26. 26.
    Yildirim N, Gursoy H, Sahin A, et al. Glaucoma after penetrating keratoplasty: incidence, risk factors, and management. J Ophthalmol. 2011;2011:951294.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Freedman J. What is new after 40 years of glaucoma implants. J Glaucoma. 2010;19(8):504–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Sarkisian Jr SR. Use of an injector for the Ex-PRESS mini glaucoma shunt. Ophthalmic Surg Lasers Imaging. 2007;38(5):434–6.PubMedGoogle Scholar
  29. 29.
    Li JY, Lim MC, Mannis MJ. Traumatic cataract associated with mini glaucoma shunt. J Cataract Refract Surg. 2011;37(7):1360–2.PubMedCrossRefGoogle Scholar
  30. 30.
    Salim S. Current variations of glaucoma filtration surgery. Curr Opin Ophthalmol. 2012;23(2):89–95.PubMedCrossRefGoogle Scholar
  31. 31.
    Pablo LE, Perez-Olivan S, Ferreras A, et al. Contact versus peribulbar anaesthesia in trabeculectomy: a prospective randomized clinical study. Acta Ophthalmol Scand. 2003;81(5):486–90.PubMedCrossRefGoogle Scholar
  32. 32.
    Dahan E. Subconjunctival insertion of Ex-PRESS R-50 miniature glaucoma implant. J Cataract Refract Surg. 2008;34(5):716; author reply −7.PubMedCrossRefGoogle Scholar
  33. 33.
    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.CrossRefGoogle Scholar
  34. 34.
    Rouse JM, Sarkisian Jr SR. Mini-drainage devices: the Ex-PRESS mini-glaucoma device. Dev Ophthalmol. 2012;50:90–5.PubMedCrossRefGoogle Scholar
  35. 35.
    Rivier D, Roy S, Mermoud A. Ex-PRESS R-50 miniature glaucoma implant insertion under the conjunctiva combined with cataract extraction. J Cataract Refract Surg. 2007;33(11):1946–52.PubMedCrossRefGoogle Scholar
  36. 36.
    Mermoud A. Ex-PRESS implant. Br J Ophthalmol. 2005;89(4):396–7.PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Gindroz F, Roy S, Mermoud A, Schnyder CC. Combined Ex-PRESS LR-50/IOL implantation in modified deep sclerectomy plus phacoemulsification for glaucoma associated with cataract. Eur J Ophthalmol. 2011;21(1):12–9.PubMedCrossRefGoogle Scholar
  38. 38.
    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.PubMedCrossRefGoogle Scholar
  39. 39.
    De Feo F, Bagnis A, Bricola G, et al. Efficacy and safety of a steel drainage device implanted under a scleral flap. Can J Ophthalmol. 2009;44(4):457–62.PubMedCrossRefGoogle Scholar
  40. 40.
    Freidl KB, Moster MR. Express shunt surgery: preferred glaucoma surgery in residency training? Surv Ophthalmol. 2012;57(4):372–5.PubMedCrossRefGoogle Scholar
  41. 41.
    Gallego-Pinazo R, Lopez-Sanchez E, Marin-Montiel J. Postoperative outcomes after combined glaucoma surgery. Comparison of ex-press miniature implant with standard trabeculectomy. Arch Soc Esp Oftalmol. 2009;84(6):293–7.PubMedCrossRefGoogle Scholar
  42. 42.
    De Feo F, Roccatagliata L, Bonzano L, et al. Magnetic resonance imaging in patients implanted with Ex-PRESS stainless steel glaucoma drainage microdevice. Am J Ophthalmol. 2009;147(5):907–11. 11.e1.PubMedCrossRefGoogle Scholar
  43. 43.
    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.PubMedCrossRefGoogle Scholar
  44. 44.
    Seider MI, Rofagha S, Lin SC, Stamper RL. Resident-performed Ex-PRESS shunt implantation versus trabeculectomy. J Glaucoma. 2012;21(7):469–74.PubMedCrossRefGoogle Scholar
  45. 45.
    Marzette L, Herndon LW. A comparison of the Ex-PRESS mini glaucoma shunt with standard trabeculectomy in the surgical treatment of glaucoma. Ophthalmic Surg Lasers Imaging. 2011;42(6):453–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Salim S, Du H, Boonyaleephan S, Wan J. Surgical outcomes of the Ex-PRESS glaucoma filtration device in African American and white glaucoma patients. Clin Ophthalmol. 2012;6:955–62.PubMedCentralPubMedCrossRefGoogle Scholar
  47. 47.
    Gandolfi S, Traverso CF, Bron A, et al. Short-term results of a miniature draining implant for glaucoma in combined surgery with phacoemulsification. Acta Ophthalmol Scand Suppl. 2002;236:66.PubMedCrossRefGoogle Scholar
  48. 48.
    Coupin A, Li Q, Riss I. Ex-PRESS miniature glaucoma implant inserted under a scleral flap in open-angle glaucoma surgery: a retrospective study. J Fr Ophtalmol. 2007;30(1):18–23.PubMedCrossRefGoogle Scholar
  49. 49.
    Stewart RM, Diamond JG, Ashmore ED, Ayyala RS. Complications following ex-press glaucoma shunt implantation. Am J Ophthalmol. 2005;140(2):340–1.PubMedCrossRefGoogle Scholar
  50. 50.
    Mosaed S, Minckler DS. Aqueous shunts in the treatment of glaucoma. Expert Rev Med Devices. 2010;7(5):661–6.PubMedCrossRefGoogle Scholar
  51. 51.
    Garg SJ, Kanitkar K, Weichel E, Fischer D. Trauma-induced extrusion of an Ex-PRESS glaucoma shunt presenting as an intraocular foreign body. Arch Ophthalmol. 2005;123(9):1270–2.PubMedCrossRefGoogle Scholar
  52. 52.
    Tavolato M, Babighian S, Galan A. Spontaneous extrusion of a stainless steel glaucoma drainage implant (Ex-PRESS). Eur J Ophthalmol. 2006;16(5):753–5.PubMedGoogle Scholar
  53. 53.
    Stein JD, Herndon LW, Brent Bond J, Challa P. Exposure of Ex-PRESS miniature glaucoma devices: case series and technique for tube shunt removal. J Glaucoma. 2007;16(8):704–6.PubMedCrossRefGoogle Scholar
  54. 54.
    Teng CC, Radcliffe N, Huang JE, Farris E. Ex-PRESS glaucoma shunt dislocation into the anterior chamber. J Glaucoma. 2008;17(8):687–9.PubMedCrossRefGoogle Scholar
  55. 55.
    Saricaoglu MS, Karakurt A, Recep OF, Hasiripi H. Retrieval of a mispositioned Ex-PRESS glaucoma device. Ophthalmic Surg Lasers Imaging. 2008;39(5):404–6.PubMedCrossRefGoogle Scholar
  56. 56.
    Bagnis A, Papadia M, Scotto R, Traverso CE. Obstruction of the Ex-PRESS miniature glaucoma device: Nd: YAG laser as a therapeutic option. J Glaucoma. 2011;20(4):271.PubMedCrossRefGoogle Scholar
  57. 57.
    Vetrugno M, Ferreri P, Cardascia N, Sborgia C. Surgical reposition of a dislocated Ex-PRESS miniature device. Eur J Ophthalmol. 2011;21(2):212–4.PubMedCrossRefGoogle Scholar
  58. 58.
    Gregory L, Khouri AS, Lari HB, Fechtner RD. Technique for intraoperative reuse of Ex-PRESS delivery system. J Glaucoma. 2013;22(4):e5–6.PubMedCrossRefGoogle Scholar
  59. 59.
    Verbraak FD, de Bruin DM, Sulak M, et al. Optical coherence tomography of the Ex-PRESS miniature glaucoma implant. Lasers Med Sci. 2005;20(1):41–4.PubMedCrossRefGoogle Scholar
  60. 60.
    Geffen N, Trope GE, Alasbali T, et al. Is the Ex-PRESS glaucoma shunt magnetic resonance imaging safe? J Glaucoma. 2010;19(2):116–8.PubMedGoogle Scholar
  61. 61.
    Buys YM. Trabeculectomy versus Ex-PRESS shunt surgery: preferred glaucoma surgery in residency training. Surv Ophthalmol. 2012;57(4):375–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Lindsay A. McGrath
    • 1
  • Graham A. Lee
    • 1
    Email author
  • Ivan Goldberg
    • 2
  1. 1.Department of OphthalmologyCity Eye Center, University of QueenslandBrisbaneAustralia
  2. 2.Department of OphthalmologySydney Eye HospitalSydneyAustralia

Personalised recommendations