Posters

Nd:YAG laser as a therapeutic option for clearing an obstructed Ex-Press P50 glaucoma filtering device

Poster Details

First Author: X.Garrell Salat SPAIN

Co Author(s):    X. Garrell-Salat   S. Banderas   D. Aragón-Roca   F. Trejo-Velasco   M. Castany   J. Rigo     

Abstract Details

Purpose:

To highlight the importance of gonioscopy after glaucoma filtering surgery with implantation of an Ex-Press P50 device, as a possible cause of failure may be the obstruction of the device due to the incarceration of iris filaments, and to show how treatment with Nd:YAG laser can successfully clear the implant.

Setting:

Glaucoma Unit. Vall d’Hebron University Hospital. Barcelona, Spain.

Methods:

We report a case of a 60-year-old man with severe bilateral primary open angle glaucoma who underwent a filtering surgery with implantation of an Ex-Press P50 Glaucoma Filtering Device in his left eye. In the following years progression was detected which did not respond to topical treatment, so a revision of the surgery was performed with Mitomycin C 0.02% and an Ologen implant, but after 3 months IOP persisted high despite suturolysis and digital massage. We performed complete ophthalmologic evaluation including slit-lamp examination, fundus examination, gonioscopic examination, photography, and optical coherence tomography (OCT).

Results:

The examination showed that the bleb was diffuse due to the Ologen implant, the anterior chamber (AC) was formed , IOP was 17 mmHg and the gonioscopy showed incarceration of iris filaments to the lumen of the Ex-Press device, which was also seen in the OCT. Nd:YAG laser was performed at the tip of the device, and an elevation of the bleb was seen, as well as a reduction of the IOP to 13 mmHg. After digital massage the IOP was 8 mmHg. Following controls showed no changes in the IOP and the Ex-Press graft persisted permeable.

Conclusions:

The most common complication related to the Ex-Press device is obstruction. However only two cases of iris filaments obstructing the device have been published. An undiagnosed hypotony causing flattening of AC and iris touch could be a cause of the formation of iris synechiae to the device. We recommend systematic gonioscopy to all cases of failure of filtering surgery with implantation of an Ex-Press device. This case supports the role of Nd:YAG as a therapeutic option to resolve cases of obstruction of an Ex-Press device regardless of the nature of the material.

Financial Disclosure:

None