title: Intermediate-term results of the Ex-PRESS miniature glaucoma implant under a scleral flap in previously operated eyes.
abstract: BACKGROUND
  To report the safety and efficacy of Ex-PRESS(TM) miniature glaucoma implant under a scleral flap in patients with previous ocular surgeries.
  
  
  METHODS
  Retrospective, non-comparative case series from a tertiary care hospital.
  
  
  METHODS
  Patients with previous cataract or failed glaucoma surgeries who had undergone implantation of the Ex-PRESS(TM) miniature glaucoma implant (R-50 and T-50), under a scleral flap, with a minimum of 1-year postoperative follow up.
  
  
  METHODS
  For postoperative outcome, success was defined as complete if intraocular pressure (IOP) was 5-21 mmHg without medication or surgical intervention, and qualified if intraocular pressure was within the same range with glaucoma medication. To compare the outcome between patients who had previous trabeculectomy or cataract surgery the definition of success was intraocular pressure of 5-15 mmHg.
  
  
  METHODS
  Intraocular pressure, number of antiglaucoma drugs, visual acuity and complications.
  
  
  RESULTS
  One hundred eyes (100 patients; mean age: 77.4 years) with a mean follow-up period of 27 ± 13.2 months (range: 12-66) were considered. Success was complete in 60 (60%) and qualified in 24 (24%) eyes. The mean preoperative IOP of 27.7 ± 9.2 mmHg (range: 14-52 mmHg) with 2.73 ± 1.1 drugs declined to 14.02 ± 5.1 mmHg with 0.72 ± 1.06 drugs at the last follow up (P < 0.0001). Causes of failure were uncontrolled intraocular pressure (11%), bleb needling (4%) and persistent hypotony (1%). The probability of success in the patients with previous cataract surgery and trabeculectomy at 3 years was 60.6% and 50.9%, respectively.
  
  
  CONCLUSIONS
  The Ex-PRESS(TM) implant under scleral flap was a safe and effective glaucoma surgery in the eyes with prior ocular surgery.
authors.affiliation: Glaucoma Service, Wills Eye Institute, Philadelphia, Pennsylvania 19107, USA.
authors.forename: Dara
authors.initials: D
authors.lastname: Lankaranian
authors.forename: M Reza
authors.initials: MR
authors.lastname: Razeghinejad
authors.forename: Arun
authors.initials: A
authors.lastname: Prasad
authors.forename: Ghasem
authors.initials: G
authors.lastname: Fakhraie
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Freitas
authors.forename: Parul
authors.initials: P
authors.lastname: Ichhpujani
authors.forename: Marlene R
authors.initials: MR
authors.lastname: Moster
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002387:Cataract Extraction; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012590:Sclera / Q000601:surgery*; D013524:Surgical Flaps; D014065:Tonometry, Ocular; D014130:Trabeculectomy; D016896:Treatment Outcome