Advances in the Surgical Management of Glaucoma – The Role of the EX-PRESS® Glaucoma Filtration Device

2012 ◽  
Vol 06 (02) ◽  
pp. 83
Author(s):  
Robert Fechtner ◽  
Leo de Jong ◽  
Elie Dahan ◽  
Malik Kahook ◽  
Marlene Moster ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Glaucoma Surgery ◽  
Filtration Surgery ◽  
Medical Laser ◽  
Scleral Flap ◽  
New Evidence ◽  
Fine Tune ◽  
Glaucoma Filtration Device ◽  
Filtration Device

Clinicians aim to arrest the glaucomatous process by reducing intraocular pressure (IOP).1–5Available strategies include medical, laser and surgical techniques. Trabeculectomy is the traditional standard drainage surgery technique to achieve this. These MIGS techniques therefore appear to be adequate for patients whose glaucomatous damage is mild to moderate and whose target IOPs fall into this range. To achieve lower IOPs in patients with more advanced visual loss, efforts have simultaneously been made to fine-tune trabeculectomy. The use of the EX-PRESS® Glaucoma Filtration Device (Alcon) under a scleral flap is one such approach. How does the EX-PRESS Glaucoma Filtration Device benefit the conventional trabeculectomy procedure? What tips and tricks can contribute to its successful use? How safe is it? Is the additional cost to our health system justifiable? The satellite symposium ‘Advances in glaucoma surgery: new evidence in filtration surgery’, held at the 2011 World Glaucoma Congress, chaired by Dr Ivan Goldberg and sponsored by Alcon, set out to try to answer these questions.

Advances in the Surgical Management of Glaucoma—The Role of the EX-PRESS® Glaucoma Filtration Device

2012 ◽  
Vol 05 (02) ◽  
pp. 81
Author(s):  
David W Cope ◽  
Robert Fechtner ◽  
Leo de Jong ◽  
Malik Kahook ◽  
Marlene Moster ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Surgical Techniques ◽  
Glaucoma Surgery ◽  
Medical Laser ◽  
Minimally Invasive Glaucoma Surgery ◽  
High Degree ◽  
Fine Tune ◽  
Glaucoma Filtration Device ◽  
Filtration Device

By reducing intraocular pressure (IOP), we aim to arrest the glaucomatous process. Our strategies include medical, laser, and surgical techniques. Trabeculectomy is the gold standard drainage surgery to achieve this; as there can be a high degree of variability in the procedure and its success depends on bleb creation, with the challenges of wound healing modulation, results remain unpredictable. Several devices are being assessed to try to achieve ‘minimally invasive glaucoma surgery’. While results will take some years to evaluate rigorously, it seems IOP levels by these means lie in the mid-teens. These minimally invasive glaucoma surgery techniques therefore would appear to be destined for patients whose glaucomatous damage is relatively mild to moderate and whose target IOPs fall into this range. To simultaneously achieve lower IOPs for patients with more advanced visual loss, efforts have been made to ‘fine-tune’ trabeculectomy. Use of the EX-PRESS® Glaucoma Filtration Device (GFD) under a scleral flap is one such approach. How does the EX-PRESS® GFD benefit the conventional trabeculectomy procedure? What tips and tricks contribute to its success? How safe is it? Is the additional cost to our health systems justifiable? This symposium, sponsored by Alcon, set out to try to answer these questions.

Complications Specific To Ex-Press™ Shunts

2013 ◽  
Author(s):  
Steven R. Jr. Sarkisian ,
Keyword(s):  
Kansas City ◽  
The United States ◽  
External Diameter ◽  
Fort Worth ◽  
Filtration Surgery ◽  
Scleral Flap ◽  
Laser Trabeculoplasty ◽  
Topical Medications ◽  
Glaucoma Filtration Device ◽  
Filtration Device

The EX-PRESS™ Glaucoma Filtration Device (Alcon Laboratories, Inc., Fort Worth, Texas) has been commercially available in the United States since 2002 and was originally developed by Optonol, Inc. (Kansas City, Kansas) for implantation directly under the conjunctiva for an indication of control of intraocular pressure (IOP). It is a nonvalved, stainless steel device almost 3 mm long with an external diameter of approximately 400 microns and a 50 or 200 micron lumen, depending on the model. It has an external disc at one end and a spur-like extension on the other to prevent extrusion. The EX-PRESS™ shunt is one option for controlling IOP available to today’s glaucoma surgeon. The challenges and complications involved with EX-PRESS™ shunts are addressed below, as well as how to manage and prevent such scenarios. The original unguarded technique of implantation under the conjunctiva resulted in numerous complications, including hypotony, extrusion, and, most commonly, erosion of the implant. Typically, there was a period of hypotony followed by failure and erosion of the implant. Endophthalmitis has also been associated with an exposed implant. To avoid complications associated with subconjunctival implantation, Dahan and Carmichael proposed implanting the device under a scleral flap. This technique has greatly reduced erosions, and EX-PRESS™ shunts have been reported to have a lower rate of hypotony than trabeculectomy (15.8% with EX-PRESS™ shunt versus 22.5% in trabeculectomy). Since 2003, the manufacturer has recommended all users only implant the device under a scleral flap. Like all filtration surgery, failure is most commonly from episcleral and subconjunctival fibrosis. As with traditional filtration surgery, intraoperative adjunctive antimetabolites, such as mitomycin-C, may be used to limit the degree of postoperative scarring. However, should failure due to fibrosis occur, there are several options. The first is to add topical medications or perform laser trabeculoplasty. The second is to perform bleb revision or needling with an antifibrotic agent. Finally, as in a failed trabeculectomy, the surgeon may abandon the EX-PRESS™ shunt and perform a second unrelated procedure.

scholarly journals EX-PRESS Glaucoma Filtration Device: Management of Complications

Vision ◽  
2020 ◽  
Vol 4 (3) ◽  
pp. 39
Author(s):  
Michele Nicolai ◽  
Alessandro Franceschi ◽  
Paolo Pelliccioni ◽  
Vittorio Pirani ◽  
Cesare Mariotti
Keyword(s):  
Surgical Procedure ◽  
Refractory Glaucoma ◽  
Filtration Surgery ◽  
Device Management ◽  
Randomized Studies ◽  
Management Of Complications ◽  
Specific Device ◽  
Outflow Pathway ◽  
Glaucoma Filtration Device ◽  
Filtration Device

The EX-PRESS glaucoma filtration device appears to be an effective addition to our options to treat refractory glaucoma. The possibility to create a sclerostomy without tissue excision provides a safe and reliable outflow pathway for aqueous that is standard in size, reducing much of the variability associated with a surgical procedure. Prospective randomized studies comparing EX-PRESS implantation with trabeculectomy show encouraging results. However, complications usually encountered in filtration surgery have been reported, and EX-PRESS implantation can also lead to specific device-related complications. This article reviews the most common complications associated with this procedure.

scholarly journals Comparison between the Express Implant and Transscleral Diode Laser in Neovascular Glaucoma

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Faried Mohammed Wagdy ◽  
Adel Galal Zaky
Keyword(s):  
Previous History ◽  
Visual Outcome ◽  
Glaucoma Surgery ◽  
Neovascular Glaucoma ◽  
Panretinal Photocoagulation ◽  
History Of ◽  
Therapeutic Tools ◽  
Endothelial Growth Factor ◽  
Glaucoma Filtration Device ◽  
Filtration Device

Purpose. To compare the outcomes of Ex-PRESS glaucoma filtration device and transscleral cyclophotocoagulation (TSCP) in the management of neovascular glaucoma (NVG). Patients and Methods. A total of 30 eyes (12 express shunts and 18 TSCP) of 28 patients were included. The eyes had NVG with intraocular pressure (IOP) more than 21 mmHg of the maximally tolerated medication treatment after previous panretinal photocoagulation and antivascular endothelial growth factor (anti-VEGF) injection, with no previous history of a cyclodestruction procedure or glaucoma surgery, were randomized either for Ex-PRESS glaucoma filtration device or TSCP. The patients were followed up weekly for the first month and then monthly for 12 months as regard to the IOP, number of topical antiglaucoma drugs required, visual outcome, and postoperative complications. Results. IOP was successfully controlled with both techniques in 83.3% of the eyes. Both techniques had fewer complications and required fewer subsequent procedures. Conclusion. Both the Ex-PRESS glaucoma filtration device and TSCP might constitute safe and alternative therapeutic tools for patients with NVG. However, TSCP is an easier procedure, less time consuming, and does not require a learning curve.

The role of Ahmed glaucoma valve in the management of refractory glaucoma: Long-term outcomes and complications

2020 ◽  
pp. 112067212096873
Author(s):  
Jade Luzu ◽  
Christophe Baudouin ◽  
Pascale Hamard
Keyword(s):  
Medical Treatment ◽  
Glaucoma Surgery ◽  
Ahmed Glaucoma Valve ◽  
Success Rates ◽  
Refractory Glaucoma ◽  
Filtration Surgery ◽  
Corneal Decompensation

Purpose: To retrospectively evaluate the efficacy and long-term complications of the Ahmed glaucoma valve (AGV) in refractory glaucoma. Materials and methods: Seventy-eight eyes with glaucoma refractory to conventional surgical procedures (filtration surgery and diode laser cyclophotocoagulation) underwent AGV implantation between May 2006 and August 2018. The criteria for success were defined as an intraocular pressure (IOP) less than 18 mmHg and a decrease of at least 20% from the preoperative IOP. The criteria for failure were an IOP greater than 18 mmHg or less than 5 mmHg, an increase in medical treatment, a decrease of less than 20% of the initial IOP, the need for another glaucoma surgery, or a decrease in visual acuity attributable to the valve. Results: IOP decreased from 31.0 ± 9.0 mmHg to 17.2 ± 7.2 mmHg (mean follow-up 32.5 months), for a mean IOP lowering of 44.5% ( p < 0.001). Medical treatment was significantly reduced from 5.3 ± 1.5 to 2.8 ± 1.9 ( p < 0.0001). The cumulative success rates were 59.4% at 3 years and 45.1% at 5 years. Encapsulation of the filtration bleb was the most common short-term complication (32.1%). Relevant long-term complications were bleb fibrosis with elevated IOP (12.8%) and corneal decompensation (10.2%). Conclusion: The AGV is an effective procedure in the long-term for controlling IOP in refractory glaucoma, with limited incidence of complications. These results suggest that the AGV might be considered earlier in the surgical strategy for glaucoma not controlled after one well-performed conventional filtration surgery.

scholarly journals EpCAM promotes endosomal modulation of the cortical RhoA zone for epithelial organization

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Cécile Gaston ◽  
Simon De Beco ◽  
Bryant Doss ◽  
Meng Pan ◽  
Estelle Gauquelin ◽  
...  
Keyword(s):  
Cell Shape ◽  
Specific Protein ◽  
Cell Polarization ◽  
Stress Fiber ◽  
Fiber Formation ◽  
Endosomal Trafficking ◽  
Transient Zone ◽  
And Behavior ◽  
Fine Tune

AbstractAt the basis of cell shape and behavior, the organization of actomyosin and its ability to generate forces are widely studied. However, the precise regulation of this contractile network in space and time is unclear. Here, we study the role of the epithelial-specific protein EpCAM, a contractility modulator, in cell shape and motility. We show that EpCAM is required for stress fiber generation and front-rear polarity acquisition at the single cell level. In fact, EpCAM participates in the remodeling of a transient zone of active RhoA at the cortex of spreading epithelial cells. EpCAM and RhoA route together through the Rab35/EHD1 fast recycling pathway. This endosomal pathway spatially organizes GTP-RhoA to fine tune the activity of actomyosin resulting in polarized cell shape and development of intracellular stiffness and traction forces. Impairment of GTP-RhoA endosomal trafficking either by silencing EpCAM or by expressing Rab35/EHD1 mutants prevents proper myosin-II activity, stress fiber formation and ultimately cell polarization. Collectively, this work shows that the coupling between co-trafficking of EpCAM and RhoA, and actomyosin rearrangement is pivotal for cell spreading, and advances our understanding of how biochemical and mechanical properties promote cell plasticity.

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