Results of the use of the Ex-PRESS miniature glaucoma implant in technically challenging, advanced glaucoma cases: A clinical pilot study

To report results of implantation of the Ex-PRESS Miniature Glaucoma Implant (Optonol, Neve Ilan, Israel) shunt directly under the conjunctiva in advanced glaucoma. Noncomparative case series. Chart review of eleven cases of Ex-PRESS implantation. Outcome measures included intraocular pressure (IOP), complications, visual acuity, and additional interventions. Failure was defined as unacceptably high IOP requiring revision or explantation. Four patients (36%) failed. Ten (91%) experienced hypotony during postoperative week one. In the seven nonfailures, mean pre and postoperative IOPs were 30.3 ± 9.3 mm Hg and 13.6 ± 4.4 mm Hg, respectively (P =. 006). The logMAR visual acuity did not change significantly from baseline to follow up (logMAR 1.1 ± 0.9 and 1.4 ± 0.9, respectively, P =. 13). There were no intraoperative complications. Postoperative complications in the 11 eyes included choroidal detachment in 3 (27%) and suprachoroidal hemorrhage in 2 (18%). Of the 7 successful cases, additional interventions were required in 4 (57%). Despite significant IOP reduction, the incidence of complications following Ex-PRESS implantation directly under the conjunctiva was unacceptably high in this group of patients.