Surgical Treatment of Neovascular Glaucoma with Ex-PRESS Glaucoma Shunt

Author(s): Cenk Zeki Fikret, Nil Irem Ucgun

Purpose: To compare the efficacy and safety profile of deep sclerectomy combined with Ex-PRESS shunt versus Ex-PRESS shunt surgery in eyes with neovascular glaucoma. Methods: Patients with neovascular glaucoma secondary to proliferative diabetic retinopathy who underwent Ex-PRESS glaucoma filtration surgery with or without deep sclerectomy were evaluated retrospectively. Twenty eyes with neovascular glaucoma secondary proliferative diabetic retinopathy were included in our study. Intravitreal bevacizumab injection and panretinal photocoag-ulation were applied to these eyes. Iris and angle neovascularization were achieved preoperatively. In spite of full antiglaucomatous treatment whose intraocular pressures were 21mm Hg and above were taken to surgery. Patients were randomly divided into two groups. Group A (10 patients) underwent deep sclerectomy combined with implantation of Ex-PRESS drainage device, group B (10 patients) underwent only Ex-PRESS glaucoma filtration surgery. Primary outcome measurements were intraocular pressure (IOP) and the number of antiglaucomatous medications at the first year follow up visit. Results: There was no difference in IOP between the groups at the first 2 months postoperatively (p>0.05). There was no need for antiglaucomatous medication in all groups in the first 2 months. Antiglaucomatous medication was administered to 2 patients in group A and to 4 patients in group B in the third month. IOP values were lower in group A than group B at the third and sixth months (p<0.05). At the end of the first year, ≤18 mm Hg IOP rate was found 80% in group A and 60% in group B without medication. Conclusions: Ex-PRESS shunt surgery demonstrated to be an effective treatment in eyes with neovascular glaucoma at the first year follow-up period. Ex-PRESS drainage device implantation with deep sclerectomy increased surgical success.

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