Abstract
The Ex-PRESS mini-glaucoma device is an alternative to traditional trabeculectomy. The device has been found to be safe, as efficacious and even superior to trabeculectomy in some aspects. For complex glaucomas, the Ex-PRESS should be considered as an alternative to glaucoma drainage implants. Winston Churchill once said, “Without tradition, art is a flock of sheep without a shepherd. Without innovation, it is a corpse.” Often in times of technological advance, progress requires a melding of tradition and innovation. Ophthalmology and glaucoma surgery are no different. Amidst a flood of minimally invasive glaucoma surgical advancements, filtration and shunt surgeries remain steadfast as definitive therapies for severe glaucoma. Trabeculectomy has remained the gold standard for glaucoma surgery; however, advances in surgical technique have even come to this decades-old procedure. The Ex-PRESS Mini-Glaucoma Device is now accepted in many circles as a modification of the trabeculectomy procedure available to many patients.
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References
Geffen N, Trope GE, Alasbali T, Salonen D, Crowley AP, Buys YM. Is the Ex-PRESS glaucoma shunt magnetic resonance imaging safe? J Glaucoma. 2010;19(2):116–8. doi:10.1097/IJG.0b013e3181a98bda.
Nyska A, Glovinsky Y, Belkin M, Epstein Y. Biocompatibility of the Ex-PRESS miniature glaucoma drainage implant. J Glaucoma. 2003;12(3):275–80.
Gandolfi S, Traverso CF, Bron A, Sellem E, Kaplan-Messas A, Belkin M. Short-term results of a miniature draining implant for glaucoma in combined surgery with phacoemulsification. Acta Ophthalmol Scand Suppl. 2002;236:66.
Stewart RM, Diamond JG, Ashmore ED, Ayyala RS. Complications following ex-press glaucoma shunt implantation. Am J Ophthalmol. 2005;140(2):340–1. doi:10.1016/j.ajo.2005.02.033.
Traverso CE, De Feo F, Messas-Kaplan A, Denis P, Levartovsky S, Sellem E, Badala F, Zagorski Z, Bron A, Gandolfi S, Belkin M. 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. doi:10.1136/bjo.2004.058032.
Wamsley S, Moster MR, Rai S, Alvim HS, Fontanarosa J. 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. doi:10.1016/j.ajo.2004.06.024.
Dahan E, Carmichael TR. Implantation of a miniature glaucoma device under a scleral flap. J Glaucoma. 2005;14(2):98–102.
Beltran-Agullo L, Trope GE, Jin Y, Wagschal LD, Jinapriya D, Buys YM. Comparison of visual recovery following Ex-PRESS versus trabeculectomy: results of a prospective randomized controlled trial. J Glaucoma. 2013. doi:10.1097/IJG.0b013e31829e1b68.
Netland PA, Sarkisian Jr SR, Moster MR, Ahmed II, Condon G, Salim S, Sherwood MB, Siegfried CJ. Randomized, prospective, comparative trial of EX-PRESS glaucoma filtration device versus trabeculectomy (XVT study). Am J Ophthalmol. 2014;157(2):433–40. doi:10.1016/j.ajo.2013.09.014. e433.
Sugiyama T, Shibata M, Kojima S, Ueki M, Ikeda T. 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. doi:10.2147/OPTH.S23129.
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. doi:10.1038/eye.2012.13.
Wang W, Zhou M, Huang W, Zhang X. Ex-PRESS implantation versus trabeculectomy in uncontrolled glaucoma: a meta-analysis. PLoS One. 2013;8(5):e63591. doi:10.1371/journal.pone.0063591.
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. doi:10.1097/IJG.0b013e31818fb44e.
Broadway DC, Bloom PA, Bunce C, Thiagarajan M, Khaw PT. Needle revision of failing and failed trabeculectomy blebs with adjunctive 5-fluorouracil: survival analysis. Ophthalmology. 2004;111(4):665–73. doi:10.1016/j.ophtha.2003.07.009.
Freidl KB, Moster MR. ExPRESS shunt surgery: preferred glaucoma surgery in residency training? Surv Ophthalmol. 2012;57(4):372–5. doi:10.1016/j.survophthal.2012.02.008.
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. doi:10.1007/s12325-009-0017-6.
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. doi:10.2147/OPTH.S18565.
Moisseiev E, Zunz E, Tzur R, Kurtz S, Shemesh G. Standard trabeculectomy and Ex-PRESS miniature glaucoma shunt: a comparative study and literature review. J Glaucoma. 2014. doi:10.1097/IJG.0000000000000047.
Wagschal LD, Trope GE, Jinapriya D, Jin YP, Buys YM. Prospective randomized study comparing Ex-PRESS to trabeculectomy: 1-year results. J Glaucoma. 2013. doi:10.1097/IJG.0000000000000029.
Cunliffe IA, Dapling RB, West J, Longstaff S. A prospective study examining the changes in factors that affect visual acuity following trabeculectomy. Eye (Lond). 1992;6(Pt 6):618–22. doi:10.1038/eye.1992.133.
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. doi:10.1016/j.ajo.2010.09.004. e501.
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. doi:10.1097/01.ijg.0000243479.90403.cd.
Seider MI, Rofagha S, Lin SC, Stamper RL. Resident-performed Ex-PRESS shunt implantation versus trabeculectomy. J Glaucoma. 2012;21(7):469–74. doi:10.1097/IJG.0b013e3182182bfb.
Chen G, Li W, Jiang F, Mao S, Tong Y. Ex-PRESS implantation versus trabeculectomy in open-angle glaucoma: a meta-analysis of randomized controlled clinical trials. PLoS One. 2014;9(1):e86045. doi:10.1371/journal.pone.0086045.
Carreno E, Villaron S, Portero A, Herreras JM, Maquet JA, Calonge M. Surgical outcomes of uveitic glaucoma. J ophthalmic inflamm infect. 2011;1(2):43–53. doi:10.1007/s12348-010-0012-8.
Siddique SS, Suelves AM, Baheti U, Foster CS. Glaucoma and uveitis. Surv Ophthalmol. 2013;58(1):1–10. doi:10.1016/j.survophthal.2012.04.006.
Sung VC, Barton K. Management of inflammatory glaucomas. Curr Opin Ophthalmol. 2004;15(2):136–40.
Ceballos EM, Beck AD, Lynn MJ. Trabeculectomy with antiproliferative agents in uveitic glaucoma. J Glaucoma. 2002;11(3):189–96.
Kaburaki T, Koshino T, Kawashima H, Numaga J, Tomidokoro A, Shirato S, Araie M. Initial trabeculectomy with mitomycin C in eyes with uveitic glaucoma with inactive uveitis. Eye (Lond). 2009;23(7):1509–17. doi:10.1038/eye.2009.117-cme.
Kok H, Barton K. Uveitic glaucoma. Ophthalmol Clin North Am. 2002;15(3):375–87. viii.
Moorthy RS, Mermoud A, Baerveldt G, Minckler DS, Lee PP, Rao NA. Glaucoma associated with uveitis. Surv Ophthalmol. 1997;41(5):361–94.
Compliance with Ethical Requirements
Dr. Allen had no conflict of interest. Dr. Sarkisian is a consultant to Alcon. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.
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9.1 Electronic Supplementary Material
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Ex-PRESS Shunt Implantation; Steven R. Sarkisian, Jr., MD (MV4 204,075 kb)
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Allan, E., Sarkisian, S.R. (2015). Ex-PRESS Miniature Glaucoma Shunt for the Treatment of Uveitic Glaucomas. In: Aref, A., Varma, R. (eds) Advanced Glaucoma Surgery. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-18060-1_9
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DOI: https://doi.org/10.1007/978-3-319-18060-1_9
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