EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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conjunctival dissection flap has basically eliminated the oc- currence of implant extrusion, com- plications can still develop, including conjunctival wound leaks and procedure failure due to con- junctival scarring. This new minimally invasive ap- Figure 7 Figure 8 proach to EX-PRESS device implan- tation offers several advantages over the current traditional method for shunt implantation. The lack of con- junctival dissection and scleral cau- terization should result in less subconjunctival scarring and per- haps a higher incidence of proce- dure success. Since no conjunctival peritomy is performed, conjunctival wound leaks have been eliminated. There is still the potential for wound leaks from the corneal opening of the scleral tunnel; however, due to the nature of the wound being com- posed of corneal stroma, this open- ing can be easily managed with a single 10-0 nylon suture. To date, a small number of glau- Figure 9 Source (all): Richard S. Hoffman, M.D. the floor of the tunnel will bury the knot in the grooved incision with- out the need for suture rotation (Figure 8). No sutures are needed in the posterior aspect of the scleral tunnel, and since no incisions are made in the conjunctiva, conjuncti- val closure is unnecessary (Figure 9). Discussion The use of the EX-PRESS device under a guarded scleral flap offers several advantages over traditional trabeculectomy. The restricted out- flow from the 50-micron lumen lim- its the incidence of hypotony and flat anterior chambers. Thus, iridec- tomies are not required, and this should result in a lower incidence of iridectomy-related hyphemas. Al- though the use of a guarded scleral coma patients have undergone this technique. Dr. Crandall has done a preliminary 3-month post-op analy- sis of five patients who underwent this technique combined with pha- coemulsification. Following implan- tation of the shunt, he injected 20 micrograms (0.1 ml of 0.2 mg/ml) of mitomycin C into the subconjuncti- val space by way of the scleral tun- nel. His preliminary data revealed an average reduction of glaucoma med- ications of 2.8 with all patients having IOPs of 16 mm Hg or less without the use of topical medica- tion. The only reported complica- tion was a late wound leak through the corneal incision from a broken 10-0 nylon suture; that resolved with a bandage contact lens. Three- month post-op data for glaucoma procedures is of course very prelimi- nary; however, it does demonstrate the potential feasibility of this tech- nique. As is true with any new pro- cedure, clinical studies with a larger cohort of patients will ultimately be required to assess the long-term via- bility of this minimally invasive technique. EW Editors' note: Dr. Hoffman has no financial interests related to this article. Contact information Hoffman: rshoffman@finemd.com Intralase & Femtosecond Spatulas Call 727-209-2244 For More Information. 3360 Scherer Drive, Suite B, St. Petersburg, FL 33716 s4EL #OME3EE5S!T!3#23"OOTH s&AX %MAIL )NFO 2HEIN-EDICAL COMs7EBSITE WWW 2HEIN-EDICAL COM 1323 Rev.A $EVELOPED)N#OORDINATION7ITH"ARRY3 3EIBEL - $ "ARBARA,EGE - $ 0AUL" 2OUSSEAU "YRON! 3TRATAS - $ 3TEPHEN! 7EXLER - $ ,UCAS4HE%LDER 6ENUS #UPID BBBB 8-16172: Seibel*, Stainless ess 05-7007: Seibel*, Titanium 8-16172-L: Lege*/Seibel*, Stainless 8-16178: Stratas*/Seibel*, Stainless S tainl 8-16179: Wexler*/Seibel*, Stainless 8 -1 6 1 R 7 3: s u o e s *, u a