EX-PRESS Glaucoma Filtration Device: Management of Complications

Abstract

The EX-PRESS glaucoma filtration device appears to be an effective addition to our options to treat refractory glaucoma. The possibility to create a sclerostomy without tissue excision provides a safe and reliable outflow pathway for aqueous that is standard in size, reducing much of the variability associated with a surgical procedure. Prospective randomized studies comparing EX-PRESS implantation with trabeculectomy show encouraging results. However, complications usually encountered in filtration surgery have been reported, and EX-PRESS implantation can also lead to specific device-related complications. This article reviews the most common complications associated with this procedure.

Deadbolt cataract due to misplanted minishunt

“…Correct minishunt positioning is crucial for preventing unwanted complications (including failure, hypotony, malposition, erosion, shunt occlusion, corneal decompensation, and infection). 1 This case is best categorized as a malpositioned minishunt causing a traumatic cataract. While not the first reported case of traumatic cataract caused by a minishunt (in a 30-year-old woman with aniridia), we believe it is the first reported case of a traumatic cataract caused by a misplanted minishunt penetrating both the iris and lens and still functioning, with its accessory ports and spur residing within the posterior chamber.…”

Ex-Press® Surgery Versus Trabeculectomy for Primary Open Angle Glaucoma with Low Preoperative Intraocular Pressure

“…Generally, the EXP has the merits of low risks of hypotonic maculopathy, choroidal detachment, and shallow anterior chamber because the amount of aqueous humor exiting the bleb from the anterior chamber is limited [11]. However, due to the limited out ow of aqueous humor, it is unclear whether the IOP can be su ciently reduced for a long term [12]. There are few reports of surgical outcomes of EXP for low-IOP glaucoma [13][14][15].…”

The Role of Automated Peripheral Iridectomy Combined with Phacoemulsification and Mini Ex-PRESS Shunt Implantation in Patients with Chronic Angle Closure Glaucoma

“…Primary open-angle glaucoma is three times more common than angle-closure glaucoma, although angle closure is responsible for 50% of blindness caused by glaucoma because of the greater morbidity of this disease. 1 The primary risk factors for angle-closure include older age, female gender, and race. 1 …”

“…Primary open-angle glaucoma is three times more common than angle-closure glaucoma, although angle closure is responsible for 50% of blindness caused by glaucoma because of the greater morbidity of this disease. 1 The primary risk factors for angle-closure include older age, female gender, and race. 1 Surgical management of chronic angle-closure glaucoma includes filtering surgery with a high rate of complications, such as shallow anterior chamber, hypotony, choroidal detachment, choroidal hemorrhage, and aqueous misdirection with significant visual impairment.…”

“…1 The primary risk factors for angle-closure include older age, female gender, and race. 1 Surgical management of chronic angle-closure glaucoma includes filtering surgery with a high rate of complications, such as shallow anterior chamber, hypotony, choroidal detachment, choroidal hemorrhage, and aqueous misdirection with significant visual impairment. 2 Other surgical treatments have been investigated, including phacoemulsification alone or combined with other procedures such as goniosynechiolysis, surgical iridectomy, endocyclophotocoagulation and glaucoma drainage devices.…”