Long-term outcomes and risk factors for failure with the EX-press glaucoma drainage device.
OBJECTIVE
To report on the long-term outcomes and risk factors for failure with the EX-PRESS shunt implanted under a scleral flap.


METHODS
Eye Department, University of Ancona, Ancona, Italy and the Oxford Eye Center, University of Witwatersrand, Johannesburg, South Africa.


METHODS
The medical records of glaucoma patients who underwent consecutive EX-PRESS implantations under a scleral flap between 2000 and 2009 were reviewed. The operations were performed by two experienced surgeons using an identical surgical technique. The potential risk factors for failure that were analysed included age, sex, race, glaucoma type, previous antiglaucoma medications, previous glaucoma surgeries, diabetes, and smoking. Complete success was defined as postoperative intraocular pressure (IOP) 5 mm Hg>IOP<18 mm Hg without antiglaucoma medications. Qualified success was defined as 5 mm Hg>IOP<18 mm Hg with or without antiglaucoma medications.


RESULTS
Two hundred and forty-eight eyes of 211 consecutive patients were included. The mean IOP was reduced from 27.63 ± 8.26 mm Hg preoperatively (n=248) to 13.95 ± 2.70 mm Hg at 5 years (n=95). The mean follow-up was 3.46 ± 1.76 years. Complete and qualified success rates decreased gradually from 83% and 85% at 1 year to 57% and 63% at 5 years follow-up, respectively. The risk factors for failure were diabetes, non-Caucasian race, and previous glaucoma surgery. Complete success rates of diabetic patients and non-Caucasian patients decreased from 63% and 75% at 1 year to 42% and 40% at 5 years follow-up, respectively.


CONCLUSIONS
EX-PRESS success rates decrease over time but compare favourably with trabeculectomy literature data. The main identifiable risk factors for failure are diabetes, non-Caucasian race, and previous glaucoma surgery.
Università Politecnica delle Marche, Clinica Oculistica, Ancona, Italy.
C
C
Mariotti
Department of Ophthalmology, University of the Witwatersrand, Johannesburg, South Africa.
E
E
Dahan
Università Politecnica delle Marche, Clinica Oculistica, Ancona, Italy.
M
M
Nicolai
Department of Ophthalmology, University of the Witwatersrand, Johannesburg, South Africa.
L
L
Levitz
Cemka-Eval, Bourg la Reine, France.
S
S
Bouee
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
D000959:Antihypertensive Agents