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Ex-PRESS Implant Reduces Intraocular Pressure in Patients With Open-Angle Glaucoma: Presented at AAO

By Deanna M Green, PhD

ANAHEIM, CA -- November 20, 2003 -- Ocular implantation of the Ex-PRESS device in patients with open-angle glaucoma (OAG) significantly lowers intraocular pressure (IOP) and reduces the need for antiglaucoma medication, according to findings presented here November 17^th at the American Academy of Ophthalmology's 2003 Annual Meeting.

Trabeculectomy is the most common surgical treatment for glaucoma. However, this procedure is not an option for patients with scarring or trauma and is associated with a number of serious complications, including infection, choroidal detachment, and choroidal haemorrhaging.

One alternative treatment for patients with OAG is the minimally invasive Ex-PRESS miniature glaucoma implant. The device was designed to reduce IOP by diverting excess aqueous humour from the anterior chamber to a subconjunctival bleb. The Ex-PRESS implant holds several advantages over traditional filtration surgery, including ease of implantation and decreased trauma to the ocular tissue.

Carlo E Traverso, MD, at the University of Genoa, Italy, and colleagues evaluated the safety and efficacy of the Ex-PRESS miniature glaucoma implant (Optonol Ltd.) when implanted in combination with cataract extraction.

The multicentre, open-label prospective study included 26 patients (mean age, 75) with OAG and impaired vision due to cataracts. Phacoemulsification cataract extraction was performed, followed by implantation of the Ex-PRESS device under the conjunctiva at the limbus. Patients were examined up to two years postoperatively.

Overall, IOP was reduced by 39.4% 6 months after implantation and by 32.5% at 2 years. More specifically, the mean IOP dropped from 24.5 mmHg preoperatively to 15.3 mmHg at 1 year and 16.6 mmHg at 2 years.

A target IOP of </=21 mmHg was achieved in 88.5% of patients at final follow up. Notably, this success rate was 69.2% when only patients who did not receive adjunct antiglaucoma medication were considered.

The average number of antiglaucoma medications used by these patients was also significantly reduced -- from 2.7 preoperatively to less than 0.5 at 24 months (P < .001). At final follow-up, seven patients were still medicated, six of whom were taking only one medication.

The most common complication was hyphema <2mm, which occurred one day after surgery in three patients and resolved within one week. Other complications included device rotation (2 patients), choroidal detachment due to rubbing (1), and erosion (1) at 2 years.

Postoperative intervention was necessary in eight patients: five required needling with 5-fluorouracil, two required 5-fluorouracil injection, and one required needling without 5-fluorouracil.

"The Ex-PRESS is a safe and effective implant for reducing IOP and antiglaucoma medications in OAG eyes in combination with cataract extraction," Dr. Traverso concluded. He also noted that "optimal positioning of the implant may further reduce the number of complications."


[Study title: Long-Term Follow-Up of the Ex-PRESS Implant in Open-Angle Glaucoma Patients. Abstract PO206]

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