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.
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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.
Sarkisian SR. The ex-press mini glaucoma shunt: technique and experience. Middle East Afr J Ophthalmol. 2009;16(3):134–7.
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.
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.
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.
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.
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.
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.
Seibold LK, Rorrer RA, Kahook MY. MRI of the Ex-PRESS stainless steel glaucoma drainage device. Br J Ophthalmol. 2011;95(2):251–4.
Nyska A, Glovinsky Y, Belkin M, Epstein Y. Biocompatibility of the Ex-PRESS miniature glaucoma drainage implant. J Glaucoma. 2003;12(3):275–80.
Dahan E, Carmichael TR. Implantation of a miniature glaucoma device under a scleral flap. J Glaucoma. 2005;14(2):98–102.
Salim S. Ex-PRESS glaucoma filtration device-surgical technique and outcomes. Int Ophthalmol Clin. 2011;51(3):83–94.
Ex-press glaucoma filtration device: directions for use. Fort Worth: Alcon Laboratories, Inc. Manufacturer’s instructions (unpublished).
Aziz H, Fantes F, Dubovy S. Histopathology of the Ex-PRESS shunt. Ophthalmic Surg Lasers Imaging. 2011;42 Online:e94–6.
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.
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.
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.
Dahan E. Ex-Press miniature glaucoma implant. Expert Rev Ophthalmol. 2007;2(6):899–909.
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.
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.
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.
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.
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.
Vetrugno M, Ferreri P, Sborgia C. Ex-PRESS miniature glaucoma device in vitrectomized eyes. Eur J Ophthalmol. 2010;20(5):945–7.
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.
Yildirim N, Gursoy H, Sahin A, et al. Glaucoma after penetrating keratoplasty: incidence, risk factors, and management. J Ophthalmol. 2011;2011:951294.
Freedman J. What is new after 40 years of glaucoma implants. J Glaucoma. 2010;19(8):504–8.
Sarkisian Jr SR. Use of an injector for the Ex-PRESS mini glaucoma shunt. Ophthalmic Surg Lasers Imaging. 2007;38(5):434–6.
Li JY, Lim MC, Mannis MJ. Traumatic cataract associated with mini glaucoma shunt. J Cataract Refract Surg. 2011;37(7):1360–2.
Salim S. Current variations of glaucoma filtration surgery. Curr Opin Ophthalmol. 2012;23(2):89–95.
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.
Dahan E. Subconjunctival insertion of Ex-PRESS R-50 miniature glaucoma implant. J Cataract Refract Surg. 2008;34(5):716; author reply −7.
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.
Rouse JM, Sarkisian Jr SR. Mini-drainage devices: the Ex-PRESS mini-glaucoma device. Dev Ophthalmol. 2012;50:90–5.
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.
Mermoud A. Ex-PRESS implant. Br J Ophthalmol. 2005;89(4):396–7.
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.
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.
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.
Freidl KB, Moster MR. Express shunt surgery: preferred glaucoma surgery in residency training? Surv Ophthalmol. 2012;57(4):372–5.
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.
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.
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.
Seider MI, Rofagha S, Lin SC, Stamper RL. Resident-performed Ex-PRESS shunt implantation versus trabeculectomy. J Glaucoma. 2012;21(7):469–74.
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.
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.
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.
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.
Stewart RM, Diamond JG, Ashmore ED, Ayyala RS. Complications following ex-press glaucoma shunt implantation. Am J Ophthalmol. 2005;140(2):340–1.
Mosaed S, Minckler DS. Aqueous shunts in the treatment of glaucoma. Expert Rev Med Devices. 2010;7(5):661–6.
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.
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.
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.
Teng CC, Radcliffe N, Huang JE, Farris E. Ex-PRESS glaucoma shunt dislocation into the anterior chamber. J Glaucoma. 2008;17(8):687–9.
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.
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.
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.
Gregory L, Khouri AS, Lari HB, Fechtner RD. Technique for intraoperative reuse of Ex-PRESS delivery system. J Glaucoma. 2013;22(4):e5–6.
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.
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.
Buys YM. Trabeculectomy versus Ex-PRESS shunt surgery: preferred glaucoma surgery in residency training. Surv Ophthalmol. 2012;57(4):375–8.
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In this 2-min video, Dr. Ike Ahmed demonstrates the insertion of the Ex-Press shunt (MPG 247224 kb)
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McGrath, L.A., Lee, G.A., Goldberg, I. (2014). Glaucoma Surgery with the Ex-Press Glaucoma Shunt. In: Samples, J.R., Ahmed, I.I.K. (eds) Surgical Innovations in Glaucoma. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8348-9_18
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DOI: https://doi.org/10.1007/978-1-4614-8348-9_18
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