Abstract
ABSTRACTPurpose: The purpose of this case series is to describe the efficacy of the EX-PRESS shunt in uveitic glaucoma.Methods: This prospective case series sequentially recruited uveitic glaucoma subjects with intraocular pressure (IOP) > 21 mm Hg despite maximal topical antiglaucoma medications from July 2012 to July 2013 in Hong Kong. All subjects received a trabeculectomy with mitomycin C (MMC) and EX-PRESS shunt implantation. The primary outcome measures included preope-rative IOP and postoperative IOP on day 1, 1 week, 1 month, and every 3 months thereafter. The secondary outcome measures included postoperative complications and follow-up procedures, pre- and postoperative Snellen best corrected visual acuity and cup-disc ratio, as well as the number of antiglaucoma medication required.Results: In a case series of five subjects with uncontrolled uveitic glaucoma, two had inactive anterior uveitis, and three had active panuveitis. The mean preoperative IOP was 35.4 ± 12.6 mm Hg on 3.8 ± 0.5 antiglaucoma eye drops. The mean day 1, 1 week and 1 month IOP's were 6.6 ± 3.7 mm Hg, 7.2 ± 3.2 mm Hg, and 12.6 ± 8.2 mm Hg, respectively. One case required subconjunctival MMC injections postoperatively; two required conjunctival resuture for leakage; and two had early postoperative hypotony that resolved after oral prednisolone. At 6 months, the mean IOP was 13.2 ± 4.6 mm Hg. Four out of five subjects had IOP < 21 mm Hg without medication, and all had IOP < 21 mm Hg with antiglaucoma medication.Conclusion: The EX-PRESS shunt demonstrates good IOP control with a propensity for hypotony in the early postoperative period in this small uveitic glaucoma series.How to cite this article: Lee JWY, Chan JCH, Qing L, Lai JSM. Early Postoperative Results and Complications of using the EXPRESS Shunt in uncontrolled Uveitic Glaucoma: A Case Series of Preliminary Results. J Current Glau Prac 2014;8(1):20-24.
Highlights
Glaucoma is a serious complication that can occur in 10 to 20% of uveitis and even a higher prevalence in cases of Fuchs heterochromic cyclitis, herpes, or sarcoidosis-related uveitis.[1,2,3] The intraocular pressure (IOP) elevation in uveitic glaucoma can be due to a number of reasons including: increased aqueous viscosity and protein,[4,5] reduced trabecular meshwork function by inflammatory cytokines, pigments, trabeculitis and eventual trabeculocyte cytotoxicity.[6]
The efficacy of the EX-PRESS has been estab lished in the use of primary open angle glaucoma (POAG), its efficacy in uveitic glaucoma is less well studied
Kaburaki et al[19] reported that the rate of hypotony following trabeculectomy for uveitic glaucoma was 28.3%; this rate was for long-standing ocular hypotony in a population of inactive uveitis at the time of surgery
Summary
Glaucoma is a serious complication that can occur in 10 to 20% of uveitis and even a higher prevalence in cases of Fuchs heterochromic cyclitis, herpes, or sarcoidosis-related uveitis.[1,2,3] The intraocular pressure (IOP) elevation in uveitic glaucoma can be due to a number of reasons including: increased aqueous viscosity and protein,[4,5] reduced trabecular meshwork function by inflammatory cytokines, pigments, trabeculitis and eventual trabeculocyte cytotoxicity.[6]. Around 21% of adults have been reported to have intermediate IOP rise after topical dexamethasone use.[7]. The treatment of IOP rise in uveitis is most commonly with topical or oral antiglaucoma medications, but the response to treatment is often variable ranging from 0 to 80% reductions. When maximal antiglaucoma medications fail to control IOP, filtration surgery is often required; the success rate in uveitic glaucoma is often poorer than that of primary glaucomas. The success rate of trabeculectomy in uveitic glaucoma, without the use of adjunctive antimetabolites, is only about 30% and slightly improved to 50% at 5 years with the use of 5-fluorouracil (5-FU).[8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
