The latest advance in glaucoma therapy in our office is the addition of Alcon’s Ex-PRESS (Excessive Pressure Regulation Shunt System) glaucoma mini-shunt to our surgical armamentarium. It is a 400-um wide by 3-mm long (the size of a grain of rice), stainless steel device that offers Dr. Lewis an additional option to address recalcitrant glaucoma cases.
The shunt was developed in Israel and has been used on a limited basis in the United States since 2002. It is particularly useful in cases that have had failed glaucoma surgery or other inflammatory conditions in the past but is now being used on a more regular basis for first-time surgical patients with glaucoma.
How Does the Mini-Shunt Work?
The shunt works by providing an alternate pathway whereby intraocular aqueous fluid is diverted from the inner, anterior chamber to a subconjunctival space outside of the eye. A filtration “bleb” is formed under the outermost tissue of the eye (conjunctiva) and below the upper eyelid. The fluid that drains to this spot is then absorbed into the general circulation. The shunt allows fluid to bypass the clogged or malfunctioning drainage system of the eye.
While doing this, it also provides excellent control of the amount of fluid that drains from the inner eye by standardizing the drainage opening. In well-controlled studies, Ex-PRESS mini-shunt surgery had a 94% success rate with a lower complication rate compared to traditional glaucoma surgery (trabeculectomy). And, it can be used on eyes that have previously had cataract surgery.
The Ex-PRESS mini-glaucoma shunt allows the surgeon to address difficult glaucoma cases with “minimally invasive” surgery. It appears to be safer than traditional glaucoma surgery because:
- No tissue is removed, which reduces any strong inflammatory response
- Your eyes are quieter because of the lower levels of inflammation; you are more comfortable and have better vision immediately after surgery (post-operative day one)
- The intraocular pressure fluctuates less in the early post-operative period which reduces the chance of a host of low intraocular pressure related complications
- The results are more predictable
Our personal experience with the Ex-PRESS mini-shunt has been very positive. And, most patients need fewer or no glaucoma medications after surgery. This device appears to represent a giant step forward in the surgical treatment of glaucoma.
If you would like to schedule a glaucoma screening and eye exam, please contact our Denver eye care office today.