Citation Information :
Lee JW, Chan JC, Qing L, Lai JS. Early Postoperative Results and Complications of using the EX-PRESS Shunt in uncontrolled Uveitic Glaucoma: A Case Series of Preliminary Results. J Curr Glaucoma Pract 2014; 8 (1):20-24.
Purpose: 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.
Merayo-Lloves J, Power WJ, Rodriguez A, Pedroza-Seres M, Foster CS. Secondary glaucoma in patients with uveitis. Ophthalmologica 1999;213(5):300-304.
La Hey E, de Vries J, Langerhorst CT, Baarsma GS, Kijlstra A. Treatment and prognosis of secondary glaucoma in Fuchs' heterochromic iridocyclitis. Am J Ophthalmol 1993 Sep;116(3): 327-340.
Miserocchi E, Waheed NK, Dios E, Christen W, Merayo J, Roque M, Foster CS. Visual outcome in herpes simplex virus and varicella zoster virus uveitis: a clinical evaluation and comparison. Ophthalmology 2002 Aug;109(8):1532-1537.
Peretz WL, Tomasi TB. Aqueous humor proteins in uveitis. Immunoelectrophoretic and gel diffusion studies on normal and pathological human aqueous humor. Arch Ophthalmol 1961 Jan;65:20-23.
Epstein DL, Hashimoto JM, Grant WM. Serum obstruction of aqueous outflow in enucleated eyes. Am J Ophthalmol 1978 Jul;86(1):101-105.
Clark AF, Lane D, Wilson K, Miggans ST, McCartney MD. Inhibition of dexamethasone-induced cytoskeletal changes in cultured human trabecular meshwork cells by tetrahydrocortisol. Invest Ophthalmol Vis Sci 1996 Apr;37(5):805-813.
Fan DS, Yu CB, Chiu TY, Wong CY, Ng JS, Pang CP, Lam DS. Ocular-hypertensive and anti-inflammatory response to rimexolone therapy in children. Arch Ophthalmol 2003 Dec;121(12): 1716.1721.
Towler HM, Bates AK, Broadway DC, Lightman S. Primary trabeculectomy with 5-fluorouracil for glaucoma secondary to uveitis. Ocul Immunol Inflamm 1995;3(3):163-170.
de Jong L, Lafuma A, Aguade AS, 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.
Maris PJ Jr, Ishida K, Netland PA. Comparison of trabeculectomy with Ex-PRESS miniature glaucoma device implanted under scleral flap. J Glaucoma 2007 Jan;16(1):14-19.
Molteno AC, Sayawat N, Herbison P. Otago glaucoma surgery outcome study: long-term results of uveitis with secondary glaucoma drained by Molteno implants. Ophthalmology 2001 Mar;108(3):605.613.
Da Mata A, Burk SE, Netland PA, Baltatzis S, Christen W, Foster CS. Management of uveitic glaucoma with Ahmed glaucoma valve implantation. Ophthalmology 1999 Nov;106(11):2168.2172.
Ceballos EM, Parrish RK, Schiffman JC. Outcome of Baerveldt glaucoma drainage implants for the treatment of uveitic glaucoma. Ophthalmology 2002 Dec;109(12):2256.2260.
Reyes M, Sarkisian SR. P200 Express shunt implantation in neovascular glaucoma, uveitic glaucoma, and primary openangle glaucoma. Invest Ophthalmol Vis Sci 2010;51:4438.
Ceballos EM, Beck AD, Lynn MJ. Trabeculectomy with antiproliferative agents in uveitic glaucoma. J Glaucoma 2002 Jun;11(3):189-196.
Prata JA Jr, Neves RA, Minckler DS, Mermoud A, Heuer DK. Trabeculectomy with mitomycin C in glaucoma associated with uveitis. Ophthalmic Surg 1994 Sep-Oct;25(9):616-620.
Wright MM, McGehee RF, Pederson JE. Intraoperative mitomycin- C for glaucoma associated with ocular inflammation. Ophthalmic Surg Lasers 1997 May;28(5):370-376.
Sung VC, Barton K. Management of inflammatory glaucomas. Curr Opin Ophthalmol 2004 Apr;15(2):136-140.
Kaburaki T, Koshino T, Kawashima H, Numaga J, Tomidokoro A, Shirato S, Araie M. Initial trabeculectomy with mitomycin C in eyes with uveitic glaucoma with inactive uveitis. Eye (Lond) 2009 Jul;23(7):1509-1517.
Buys YM. Trabeculectomy with ExPRESS: weighing the benefits and cost. Curr Opin Ophthalmol 2013 Mar;24(2): 111-118.
Woreta F, Thorne JE, Jabs DA, Kedhar SR, Dunn JP. Risk factors for ocular complications and poor visual acuity at presentation among patients with uveitis associated with juvenile idiopathic arthritis. Am J Ophthalmol 2007 Apr;143(3):647-655.
Murphy CC, Burnett CA, Spry PG, Broadway DC, Diamond JP. A two centre study of the dose-response relation for transscleral diode laser cyclophotocoagulation in refractory glaucoma. Br J Ophthalmol 2003 Oct;87(10):1252.1257.