title: Implantation of a miniature glaucoma device under a scleral flap.
abstract: OBJECTIVE
  To test the safety and efficacy of the Ex-PRESS miniature glaucoma device when it is implanted under a scleral flap instead of under the conjunctiva as it was originally suggested.
  
  
  METHODS
  Between November 2000 and February 2003, the Ex-PRESS implant was inserted in 24 eyes of 23 patients with severe open angle glaucoma. Sixteen eyes of the 24 (66%) had had previous failed filtering surgery. The remaining 8 eyes (33%) were high risk for failures cases. A 5 x 5 mm limbal-based, 50% depth, scleral flap was raised into clear cornea. The Ex-PRESS implant was inserted into the anterior chamber under the scleral flap at the limbus. The scleral flap was securely sutured back, as is done in trabeculectomy operations.
  
  
  RESULTS
  The intraocular pressure was significantly reduced from 27.2 +/- 7.1 mm Hg pre-operatively to 14.5 +/- 5.0 mm Hg at 12 months (n = 21) and 14.2 +/- 4.2 mm Hg at 24 months (n = 8). Postoperatively, only two patients needed anti-glaucoma medications to keep the IOP below 21 mm Hg.
  
  
  CONCLUSIONS
  The Ex-PRESS device was found to be safe and effective with few complications when it is implanted under a scleral flap even in the high-risk patients studied.
authors.affiliation: Department of Ophthalmology, University of the Witwatersrand, Johannesburg, South Africa. dahaneli@mweb.co.za
authors.forename: Elie
authors.initials: E
authors.lastname: Dahan
authors.forename: Trevor R
authors.initials: TR
authors.lastname: Carmichael
mesh_terms: D000328:Adult; D000368:Aged; D000867:Anterior Chamber / Q000601:surgery*; D005260:Female; D020327:Glaucoma Drainage Implants; D005902:Glaucoma, Open-Angle / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods*; D012449:Safety; D012590:Sclera / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome