Results of the use of the Ex-PRESS miniature glaucoma implant in technically challenging, advanced glaucoma cases: a clinical pilot study.

PURPOSE: To report results of implantation of the Ex-PRESS Miniature Glaucoma Implant (Optonol, Neve Ilan, Israel) shunt directly under the conjunctiva in advanced glaucoma.

DESIGN: Noncomparative case series.

METHODS: Chart review of eleven cases of Ex-PRESS implantation. Outcome measures included intraocular pressure (IOP), complications, visual acuity, and additional interventions. Failure was defined as unacceptably high IOP requiring revision or explantation.

RESULTS: Four patients (36%) failed. Ten (91%) experienced hypotony during postoperative week one. In the seven nonfailures, mean pre and postoperative IOPs were 30.3 +/- 9.3 mm Hg and 13.6 +/- 4.4 mm Hg, respectively (P = .006). The logMAR visual acuity did not change significantly from baseline to follow up (logMAR 1.1 +/- 0.9 and 1.4 +/- 0.9, respectively, P = .13). There were no intraoperative complications. Postoperative complications in the 11 eyes included choroidal detachment in 3 (27%) and suprachoroidal hemorrhage in 2 (18%). Of the 7 successful cases, additional interventions were required in 4 (57%).

CONCLUSIONS: Despite significant IOP reduction, the incidence of complications following Ex-PRESS implantation directly under the conjunctiva was unacceptably high in this group of patients.