Clinical curative effect of Ex-press glaucoma drainage device implantation for refractory glaucoma and related complications

Abstract:

AIM:To explore the clinical efficacy of Ex - PRESS drainage device implantation for refractory glaucoma and related complications.

METHODS: Fifty-three cases(56 eyes)were randomly selected in our hospital from February 2013 to August 2014 who received Ex-press glaucoma drainage device implantation for refractory glaucoma, 39 males(41 eyes)and 14 females(15 eyes), 52.63±10.58 years old; 25 cases(26 eyes)with neovascular glaucoma, 16 patients(18 eyes)with failure of glaucoma filtration surgery, 6 cases(6 eyes)with secondary glaucoma after vitrectomy, and 6 cases(6 eyes)with glaucoma secondary to complicated ocular trauma. Postoperative visual acuity, intraocular pressure(IOP), anterior chamber depth, corneal endothelial cell density and complications, etc. at 1 and 12mo were analyzed and compared with the preoperative.

RESULTS: At 12mo after operation, the complete success rate was 62%(35 eyes), the partial success rate was 14%(8 eyes), and the total success rate was 77%. The effective rate was 85% in patients with neovascular glaucoma, 56% in patients with failure of glaucoma filtration surgery, 100% in patients with glaucoma secondary to complicated ocular trauma, 83% in patients with secondary glaucoma after vitrectomy. At 1mo after surgery, visual acuity improved in 28 eyes(50%), unchanged in 18 eyes(32%), decreased in 10 eyes(18%). At 12mo after surgery, visual acuity improved in 19 eyes(34%), unchanged in 18 eyes(32%), decreased in 19 eyes(34%). Preoperative IOP was 29.58±8.66 mmHg, that at 1mo after surgery was 12.75±5.66mmHg, and the difference was significant(P<0.05). There were 56 eyes with decreased IOP(100%). IOP at 12mo after surgery was 9.8-28.4(mean 15.42±4.09)mmHg, which was lower than that before surgery(P<0.05). IOP were increased in 2 eyes, unchanged in 0, decreased in 54 eyes(96%)at 12mo. The corneal endothelial cells was 1958.22±168.30 and 1793.99±201.55/mm², respectively, both decreased compared to that before surgery(2113.47±80.56/mm², P<0.01). The total occurrence of postoperative complications was 29%, of which the early postoperative shallow anterior chamber with ocular hypotension was in 4 eyes, transient high IOP in 3 eyes, drainage tube obstruction in 5 eyes, and hyphema in 3 eyes. Late complication of cystic bubble with local doming was found in 1 eye.

CONCLUSION: Ex-press glaucoma drainage device implantation for refractory glaucoma, although has some complications, still achieve better clinical efficacy, and is an effective method for refractory glaucoma.

Key words:refractory glaucoma; the Ex-press glaucoma drainage device; clinical study