The Short-Term Clinical Observation Of The Application Of ExPress Glaucoma Filtration Device For The Treatment Of Refractory Glaucoma

Objective:To evaluate the short-term clinical efficacy and safety of ExPRESS glaucoma filtration device implantation for the treatment of refractory glaucoma.Methods:This was a retrospective study of29eyes of28cases with refractory glaucoma implanted ExPRESS glaucoma filtration device. The preoperative and postoperative best corrected visual acuity (BCVA), preoperative intraocular pressure (IOP) at lweek,1month, and3months after surgery, and postoperative complications were observed. According to the loose criterion (≤21mmHg), medium criterion (≤16mmHg), strict criterion (≤12mmHg), and personal target IOP, the acceptability rate of postoperative IOP at1week,1month, and3months was evaluated by Chi-square test. The comparison of the IOP among before the surgery,1week,1month, and3months after surgery were analyzed by analysis of variance (ANOVA) and least significant difference (LSD). The postoperative IOP at3months from8eyes with refractory glaucoma, which received the implantation of Ahmed glaucoma valve, was compared with the IOP at3months from18eyes that continue to follow up by t test.Result:Twenty-nine eyes of28patients with refractory glaucoma were included, of which15eyes were presented with recurrent glaucoma,6eyes with neovascular glaucoma,5eyes with aphakia,3eyes after uveitis,3eyes after vitrectomy, and2eyes with lens dislocation after trauma. After3months of follow-up, BCVA of13eyes improved,11eyes unchanged and3eyes decreased, except for2eyes with no light perception preoperatively. The IOP of eyes before surgery were31.72±8.76mmHg, and9.5±2.62mmHg,13.17±9.27mmHg,14±5.38mmHg at1week,1month, and3months after surgery, respectively. As for reaching the standard,96.55%of eyes were controlled under strict criterion,100%under medium and loose criterion at1week after surgery. However, at1month after surgery,80.77%,84.62%and96.15%of eyes were controlled under strict, medium and loose criterion, respectively. Furthermore, the respective proportions were50.0%,77.78%and94.44%at3months after surgery. Meanwhile,100%of eyes reached personal target IOP level at lweek after surgery, and76.92%at1month,44.44%at3months. The difference was found to be significant (P=0.000) when we compared the IOP before surgery with IOP after surgery in lweek,1month and3months. The comparison of the IOP among before the surgery,1week,1month, and3months after surgery done using LSD showed that there were no significant difference between1week and1month (P=0.123), between1week and3months(P=0.059), and between1month and3months (P=0.724). As for the complications,3eyes appeared filtering bleb leakage,5eyes with shallow anterior chamber or choroidal detachment,1eye with ExPRESS obstruction, and1eye with filtering bleb scarring. The mean IOP of8eyes with the implantation of Ahmed glaucoma valve was13.0±3.93mmHg, there was no significant difference compared the IOP with the implantation of ExPRESS glaucoma filtration device (P=0.588).Conclusion:The use of the ExPRESS glaucoma filtration device for the treatment of refractory glaucoma was safe and effective for maintaining the BCVA, controlling IOP, and decreasing the complication at the early stage after surgery. In this period, the implantation of ExPRESS can acquire the same availability for controlling of IOP as the use the Ahmed glaucoma valve.