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Orna Geyer

Orna Geyer

Carmel Medical Center, Israel

Title: Ex-PRESS miniature glaucoma shunt versus ahmed glaucoma valve in the surgical treatment of glaucoma in pseudophakic patients

Biography

Biography: Orna Geyer

Abstract

Statement of the Problem: Following the Tube Versus Trabeculectomy (TVT) study there has been a growing trend toward using tube-shunts rather than trabeculectomy in eyes with previous cataract extraction and/or failed glaucoma surgery. The TVT study however, examined only the Baerveldt implant and it is unknown whether the study results are applicable to other tube-shunts. The Ahmed Glaucoma Valve (AGV) is one of the most popular tube shunts. In recent years, trabeculectomy has been improved by the use of the Ex-PRESS shunt implanted under a scleral flap. Studies which directly compared AGV implantation versus Ex-PRESS surgery, showed similar outcomes for both operations, in complicated glaucoma cases. The purpose of this study was to compare outcomes of AGV and Ex-PRESS surgeries in pseudophakic patients, a group of patients similar to that in the TVT study.

Methodology & Theoretical Orientation: The records of patients who underwent AGV implantation or Ex-PRESS surgery and had prior clear-corneal phacoemulsification alone or failed trabeculectomy following phacoemulsification were reviewed. Surgical success was defined as IOP between 5 mmHg and 21 mmHg and a 20% IOP reduction from baseline (with/without glaucoma medications) without glaucoma reoperation.

Findings: Ninety two patients (92 eyes) were included (43 AGV, 49 Ex-PRESS). Overall success at 3 years was 92.7% for AGV and 66.1% for Ex-PRESS (P=0.006). Glaucoma reoperation rates was lower for AGV than for Ex-PRESS (4.6% and 30.6%, respectively, p=0.001). Similar rates of surgical success were observed with both implants, for patients with only previous phacoemulsification (87.5% AGV vs. 69.4% Ex-PRESS, P=0.205). AGV however, had a higher success rate in patients with failed trabeculectomy (96% AGV vs. 64.1% Ex-PRESS, P=0.023).

Conclusion & Significance: In patients with prior clear-corneal phacoemulsification, AGV compared to Ex-PRESS shunt has similar success rate for primary surgeries and higher success rate for secondary surgeries.