Ex-PRESS Implantation Combined With Phacoemulsification Used In Primary Angle Closure Glaucoma And Cataract

Purposes:To evaluate the efficacy and safety Ex-PRESS, a miniature glaucoma drainage device, for the surgical treatment of primary angle-closure glaucoma (PACG) and cataract when combined with phacoemulsification. Also to prove that the anterior chamber structure of those PACG patient meets the requirements of Ex-PRESS implantation after phacoemulsification.Methods:A clinical, prospective, consecutive, non-randomized, study. From September2013to September2014,25eyes of20patients with the diagnosis of PACG and cataract were enrolled as the trial group. They were implanted with Ex-PRESS device along with phacoemulsification and in the bag IOL implantation. At the same time,21eyes of18of primary open angle glaucoma (POAG) patients were enrolled to compare the anterior segment structures. The implantation of Ex-PRESS device alone was conducted. Data were collected before operation and on the day1, day7, also1,3, and6month after operation, which included intraocular pressure (IOP), best corrected visual acuity (BCVA), complications, and anterior segment structure data, including depth of anterior chamber (ACD), angle opening distance (AOD500), trabecular-iris angle (TIA), trabecular-ciliary process distance (TCPD) and draining cannula’s long axis-corneal endothelium angle (ACA). Surgical success was defined as6mmHg<IOP<21mmHg, while visual acuity decrease was no more than two lines (Snellen), with medication (partial success) or without medication (complete success).Results:At6th month after surgery, the success rate was92%in trial group, which included a complete success rate of88%. Also, mean intraocular pressure was significantly reduced compared with baseline (P<0.001). At6month after operation, the mean IOP was15.7±3.5mmHg. As cataract was removed, BCVA of control group was significantly improved (P<0.05). On the first day after operation,3eyes (12%) of the trial group and4eyes (19%) of the control group had IOP lower than6mmHg. However, IOP of all those eyes increased to normal range spontaneously on day7without a further influence of surgical efficacy. As for the anterior segment structures, ACD, AOD500, TIA, TCPD, and ACA of trial group was significantly increased after operation (P<0.001), and became similar with control group (P>0.05).Conclusions:Anterior chamber depth was increased and angle was wider after removing the cataract by phacoemulsification. If combined with phacoemulsification, Ex-PRESS miniature glaucoma device implantation was safe with a significant IOP lowering effect in patients of PACG and cataract. The results of this study can be considered as a clinical evidence for the expansion of surgical indications.