Intraocular pressure reduction in neovascular glaucoma using Ex-PRESS implantation

Abstract

Purpose: evaluation of the role of the Ex-PRESS device implantation in IOP reduction of neovascular glaucoma. Design: non-comparative case series study. Patients and methods: 5 eyes with neovascular glaucoma scheduled to undergo Ex-PRESS glaucoma filtration device. Each study patient underwent a complete ophthalmic examination preoperatively including full clinical history taking, VA measurement, autorefraction examination, slit lamp biomicroscopy of the anterior segment, IOP measurement using Goldmann applanation tonometer, gonioscopic examination to evaluate of the angle of AC, and ophthalmoscopy of the posterior segment using a direct ophthalmoscopy. All patients included were having neovascular OAG (angle grade 3 and 4 on Shaffer classification). Patients were excluded if they were under 18 years old. All eyes underwent Ex-PRESS device implantation performed by the same surgeon for consistency, using the standardized technique for the procedure. A complete ophthalmologic follow-up examination included IOP measurement using Goldmann applanation tonometry, number of drugs required to attain IOP control and any associated complications was carried out postoperatively at the 1st and 3rd days, the end of 1st week, every month till the end of the 6th month and the end of 1st year. Best-corrected visual acuity (BCVA) was tested using Snellen chart, which was converted to LogMAR for statistical analysis. Criteria for success were defined as follows; Absolute success: IOP ≤21 mmHg without any medication, qualified success: IOP ≤21 mmHg with ocular hypotensive medications. Results: all cases (100%) showed qualified success. There is a statistically significant reduction in IOP 1, 3, 6 months and one year postoperatively (P 21 mmHg using anti-glaucoma medications by this time. There is a statistically significant improvement of postoperative BCVA (P=0.002). Moreover, there is a statistically significant reduction of number of anti-glaucoma medications used postoperatively (P<0.001). Conclusion: Ex-PRESS is preferable for neovascular glaucoma.