title: Results of the use of the Ex-PRESS miniature glaucoma implant in technically challenging, advanced glaucoma cases: a clinical pilot study.
abstract: OBJECTIVE
  To report results of implantation of the Ex-PRESS Miniature Glaucoma Implant (Optonol, Neve Ilan, Israel) shunt directly under the conjunctiva in advanced glaucoma.
  
  
  METHODS
  Noncomparative case series.
  
  
  METHODS
  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.
  
  
  RESULTS
  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%).
  
  
  CONCLUSIONS
  Despite significant IOP reduction, the incidence of complications following Ex-PRESS implantation directly under the conjunctiva was unacceptably high in this group of patients.
authors.affiliation: William and Anna Goldberg Glaucoma Service and Research Laboratory, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA.
authors.forename: Sonja
authors.initials: S
authors.lastname: Wamsley
authors.forename: Marlene R
authors.initials: MR
authors.lastname: Moster
authors.forename: Sushma
authors.initials: S
authors.lastname: Rai
authors.forename: Heryberto S
authors.initials: HS
authors.lastname: Alvim
authors.forename: Joann
authors.initials: J
authors.lastname: Fontanarosa
mesh_terms: D003228:Conjunctiva / Q000601:surgery*; D005901:Glaucoma / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure; D007431:Intraoperative Complications; D010865:Pilot Projects; D011183:Postoperative Complications; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity