ANALYSIS OF HYPOTENSIVE EFFECT OF EX-PRESS DRAINAGE DEVICE FOR REFRACTORY GLAUCOMA

Purpose: to analyze the effectiveness of Ex-Press drainage device implantation  for refractory glaucoma  of different origin for 3 years.

Patients and methods: The study  consisted of 82 patients (86  eyes)  with refractory  glaucoma  aged  26–86 years  (67.37±0.53). Pre-operative  IOP level averaged 37.8±1.04  mm  Hg.  Ex-Press  drainage device  implantation  was  rated according to  the  following criteria: IOP, time course of visual functions,  the need  for additional drug therapy  and reoperation, the presence of intraoperative and postoperative complications. Examination of the  patients was carried out from 1 to 8 days after  the  surgery and within 1, 3, 6, 12, 24 and 36 months.

Results: According to our research results relative hypotensive effect equaled  74.4% (64/86) within a year after the  surgery; 67.4% (58/86) — within 2 years;  65.1% (56/86) — after  3 years  of follow-up period.  The maximum decrease in IOP by 61.6% was observed immediately after  the  surgery. There  was no effect of surgical  treatment within3 years  in 34.9% (30/86). Complications  were  observed  in 23.2% (20/86) of cases: choroidal  detachment — 12.8% (11/86),  hyphema  — 3.5% (3/86), eruption  and  dislocation  — 3.5% (3 / 86), delayed  expulsive hemorrhage — 2.3% (2/86), cyst of filtering bleb — 1.2% (1/86).

Conclusion. Fistulizing operations with implantation  of Ex-Press drainage device for refractory glaucoma  provide normalization  of IOP in 65.1% of cases (including 15.1% on the background of additional drug therapy)  at follow-up period up to 3 years.

1. Quigley H.A., Broman A.T. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006;90:262‑267.

2. Glaucoma. [National guidance. ed. by Egorov E. A.] M. : GEOTAR‑Media 2013; 824. (in Russ.).

3. Fea A.M., Belda J.I., Rękas M., Jünemann A., Chang L. Prospective unmasked randomized evaluation of the iStent inject versus two ocular hypotensive agents in patients with primary open‑angle glaucoma. Clin Ophthalmol. 2014;8:875‑882. doi: 10.2147/OPTH.

4. Bikbov M.M., Khusnitdinov I.I. The results of the use of Ahmed valve in refractory glaucoma surgery. Journal of Current Glaucoma Practice. 2015; 9(3):86‑91. doi: 10.5005/jp‑journals‑10008‑1191.

5. Bikbov M.M., Khusnitdinov I.I. [Canaloplasty in glaucoma: surgical procedure and results]. Kanaloplastika pri glaukome: khirurgicheskaya tekhnika i rezul'taty. [Clinical Ophthalmology]. Klinicheskaya oftal'mologiya. 2014;15(2):78‑81. (in Russ.).

6. Bikbov M.M., Surkova V.K., Orenburkina O.I., Khusnitdinov I.I. Chajka O.V. [The outcomes of refractory glaucoma surgery using collagen bio‑implant]. Rezul'taty khirurgicheskogo lecheniya refrakternoy glaukomy s ispol'zovaniem kollagenovogo biodrenazha. [Оphthalmology in Russia]. Oftal'mologiya. 2014;11(2):55‑58. (in Russ.). DOI: http://dx.doi.org/10.18008/1816‑5095‑2014‑2‑55‑58

7. Bikbov M.M., Khusnitdinov I.I. [Canaloplasty in patients with primary open angle glaucoma]. Kanaloplastika u patsientov s pervichnoy oktrytougol'noy glaukomoy. [Annals of Orenburg State University]. Vestnik Orenburgskogo gosudarstvennogo universiteta. 2015;187(12):35‑37. (in Russ.).

8. De Jong L, Lafuma A., Aguadé A.S., 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;5:527–533. doi: 10.2147/OPTH.S18565

9. Dreyer E.B., Dreyer R.E. Two Cases of Suprachoroidal Hemorrhage after Implantation of an Ex‑Press Miniature Glaucoma Device and an Intraocular Lens. Ophthalmol Med. 2014;2014:1‑3. doi.org/10.1155/2014/294921.

10. Mermoud А. Ex‑PRESS implant. Br. J. Ophthalmol. 2005;89:396‑397.

11. Wamsley S. 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):1049‑1051.

12. Dahan E.L., Carmichael T.R. Implantation of a miniature glaucoma device under scleral flap. J. Glaucoma. 2005;14(2):98‑102.

13. Kuroedov A.V., Ogorodnikov V.Y [Microdrainage using the Ex‑Press mini shunt as an option of surgical treatment of patients with primary open‑angle glaucoma advanced stages of the disease]. Mikrodrenirovanie s pomoshch'yu Ex‑PRESS mini‑shunta kak variant vybora operativnogo lecheniya patsientov s pervichnoy otkrytougol'noy glaukomoy prodvinutykh stadiy bolezni. [Оphthalmology in Russia]. Oftal'mologiya. 2010;7(1):23‑28. (in Russ.).

14. Erichev V.P., Asratyan G.K. [Efficacy and safety in micro‑shunting primary glaucoma surgery]. Effektivnost' i bezopasnost' mikroshuntirovaniya v khirurgii pervichnoy glaukomy. [National Journal glaucoma]. Natsional'nyi zhurnal glaucoma. 2012;4:50‑54. (in Russ.).

15. Gusev J.A., Bessonov I.L., Trubilin V.N. [Single‑step primary open‑angle glaucoma and complicated cataract surgery using modified technique of stainless steel Glaucoma Filtration Device implantation]. Odnomomentnoe khirurgicheskoe lechenie otkrytougol'noy glaukomy i oslozhnennoy katarakty s ispol'zovaniem modifitsirovannoy tekhniki implantatsii metallicheskogo mini‑shunta. [Оphthalmology in Russia]. Oftal'mologiya. 2013;10(4):21‑25. (in Russ.). DOI: http://dx.doi.org/10.18008/1816‑5095‑2013‑4‑21‑25

16. Erichev V.P., Asratyan G.K. [Micro‑shunting like starting surgery with primary glaucoma]. Mikroshuntirovanie kak startovoe khirurgicheskoe vmeshatel'stvo pri pervichnoy glaukome. Klinicheskaya oftal'mologiya, [Clinical Ophthalmology]. 2014;2:76‑78. (in Russ.).

17. Astakhov S.Y., Harsha A.A. [An effective method of surgical treatment of patients with refractory glaucoma with Ex‑press filtering device]. Effektivnyy metod khirurgicheskogo lecheniya bol'nykh refrakternoy glaukomoy s ispol'zovaniem fil'truyushchego ustroystva Ex‑press. [Ophthalmology Jouranal]. Oftal'mologicheskie Vedomosti. 2013;(1):3‑8. (in Russ.).

18. Avetisov S.E., Erichev V.P., Asratyan G.K., Avetisov K.S., Kobzova M.V. [Micro‑shunting in glaucoma surgery in pseudophakic eyes]. Mikroshuntirovanie v khirurgii glaukomy v artifakichnykh glazakh. [National Journal glaucoma]. Natsional'nyi zhurnal glaucoma. 2013;3:44‑47. (in Russ.).

19. Kryachko N.S., Pureskin N.P., Migal S.F., Migal D.S. [The results of the of the shunt Ex‑Press and drainage «Glauteks» application in treatment of secondary glaucoma]. Rezul'taty primeneniya shunta Ex–Press i drenazha «Glauteks» v kompleksnom lechenii vtorichnoy glaukomy. [Glaucoma News]. Novosti glaukomy. 2015;1(33):129‑131. (in Russ.).