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Ex-PRESS Miniature Glaucoma Shunt Versus Ahmed Glaucoma Valve in the Surgical Treatment of Glaucoma in Pseudophakic Patients

Rabkin-Mainer, Zoya, MD*; Wolf, Alvit, MD*; Mathalone, Nurit, MD*; Melamud, Alina, MD*; Buckman, Gila, MD*; Edmunds, Beth, MD; Stein, Nili, MPH; Steinberg, David M., PhD§; Geyer, Orna, MD*

doi: 10.1097/IJG.0000000000001050
Original Studies

Purpose: The aim of this study was to compare the 3-year outcome of Ex-PRESS miniature glaucoma shunt versus Ahmed glaucoma valve in pseudophakic patients.

Patients and Methods: We retrospectively reviewed the records of patients with a history of clear corneal phacoemulsification alone, or failed trabeculectomy following phacoemulsification, who subsequently underwent Ahmed glaucoma valve (AGV) implantation or Ex-PRESS shunt surgery. The main outcome measure, surgical success, was defined as an intraocular pressure between 5 and 21 mm Hg and a 20% intraocular pressure reduction from baseline (with/without glaucoma medications) without glaucoma reoperation.

Results: In total, 92 patients (92 eyes) were included (43 AGV, 49 Ex-PRESS). Overall success at 3 years was 92.7% for AGV and 66.1% for Ex-PRESS (P=0.006). AGV had a higher success rate in patients with prior phacoemulsification and failed trabeculectomy (96% AGV vs. 64.1% Ex-PRESS; P=0.023). There was no difference in success rate for patients with only previous phacoemulsification (87.5% AGV vs. 69.4% Ex-PRESS; P=0.205). Glaucoma reoperation rates were 4.6% and 30.6% in the AGV and Ex-PRESS group, respectively (P=0.001). Both procedures had similar complication rates.

Conclusions: AGV compared with Ex-PRESS shunt, had a higher success rate for secondary surgeries but not primary surgeries, in patients with prior clear corneal phacoemulsification. The AGV surgery also had a lower overall glaucoma reoperation rate.

*Department of Ophthalmology Carmel Medical Center, Haifa, Israel, affiliated to the Rapaport Faculty of Medicine, The Technion

Community Medicine and Epidemiology,Carmel Medical Center, Haifa

§Department of Statistics and Operations Research, Tel Aviv University, Tel Aviv, Israel

Casey Eye Institute, Oregon Health and Science University, Portland, OR

B.E. is supported by an unrestricted grant from Research to Prevent Blindness.

Disclosure: The authors declare no conflict of interest.

Reprints: Orna Geyer, MD, Department of Ophthalmology, Carmel Medical Center, 7 Michal Street, Haifa 34362, Israel (e-mail:

Received March 17, 2018

Accepted August 1, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.