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Ex-PRESS safe, efficacious alternative to trabeculectomy

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BARCELONA, Spain — Long-term results with a miniature stainless steel glaucoma implant with a 50-µm lumen gave patients a decreased need for intraocular pressure-lowering medications, results from a study indicate.

According to Carlo E. Traverso, who presented at the International Glaucoma Symposium, the Ex-PRESS implant (Optonol) was implanted in 10 eyes of nine white patients with open angle glaucoma and cataract. For cataract extraction, clear cornea phacoemulsification was performed on the temporal side. No intraoperative antimetabolites were used. The Ex-PRESS was implanted at the limbus with an introducer, through a snip conjunctival incision.

“The Ex-PRESS implant is a replacement for trabeculectomy,” Dr. Traverso said. “It is not indicated for patients with complicated glaucoma.”

In terms of safety results, Dr. Traverso said there was one device reposition at 2 months postop. Another patient had the implant touch the iris at 3 months postop. In the latter patient, Dr. Traverso explained that the implant rotated sideways, and this particular patient had thinner-than-normal conjunctiva and no previous surgery. Risk of erosion is great if the implant isn’t flush with the sclera, according to Dr. Traverso. No flat chambers, infection and hypotony were reported in any patient. Mean IOP dropped significantly from 26.8 mm Hg preoperatively to 16.2 mm Hg at week 52. At 75 weeks, mean IOP was 17 mm Hg.