Long-term Evaluation of the Efficacy and Safety of the EX-PRESS® Glaucoma Drainage Device in the Treatment of Primary Open-Angle Glaucoma: A Five-Year

Overview

Aim: To evaluate the long-term efficacy and safety of the EX-PRESS glaucoma drainage device implantation in patients with primary open-angle glaucoma over a five-year follow-up period.

Materials and Methods: The retrospective analysis included 77 eyes of 58 patients (28 women, 30 men) who underwent EX-PRESS glaucoma drainage device implantation between 2011 and 2020. The follow-up period was 60 months for all eyes. The evaluated parameters included intraocular pressure (IOP), the need for and type of antiglaucoma medication, best-corrected visual acuity (BCVA), optic nerve head findings, mean deviation (MD) of visual field testing, and the incidence of postoperative complications. The indication for surgery was primary open-angle glaucoma which was insufficiently controlled despite maximally tolerated medical therapy.

Results: Mean intraocular pressure (IOP) was reduced from 23.55 ±9.54 mmHg preoperatively to 12.61 ±6.83 mmHg at 3 months, 13.04 ±3.95 mmHg at 12 months, 13.39 ±3.33 mmHg at 24 months, 13.48 ±3.75 mmHg at 36 months, 13.53 ±3.23 mmHg at 48 months, and 13.52 ±2.96 mmHg at 60 months. After surgery, a marked reduction in antiglaucoma medication was observed. A total of 84.4% of eyes required no medication at 3 months, decreasing to 72.7% at 12 months, 49.4% at 24 months, 42.9% at 36 months, 42.9% at 48 months, and 42.9% at 60 months. The mean number of antiglaucoma medications decreased from 3.19 to 1.09, representing a 66% reduction. No intraoperative complications were observed. Early postoperative complications included hypotony in 6 eyes, choroidal detachment in 14 eyes, subconjunctival hemorrhage in 5 eyes, iris incarceration in 2 eyes, and conjunctival suture loosening in 6 eyes. Late postoperative complications included filtration failure in 1 eye, endophthalmitis in 1 eye, and implant obstruction in 2 eyes. In one case, PRESERFLO™ MicroShunt implantation was performed 5 years after EX-PRESS implantation.

Conclusion: EX-PRESS glaucoma drainage device implantation is an effective surgical method for the treatment of glaucoma, which provides long-term stability. It enables a significant reduction of intraocular pressure with a concurrent decrease in the need for antiglaucoma medication, and demonstrates an acceptable safety profile over a five-year follow-up period.

Keywords:

intraocular pressure – primary open-angle glaucoma – filtration surgery – EX-PRESS implant – antiglaucoma medication