The potential of ExPRESS Mini Glaucoma Shunt implantation in the treatment of secondary glaucoma induced by silicone oil emulsification in patients after vitrectomy
Abstract
PURPOSE: To determine the efficiency of combining ExPRESS glaucoma filtration device and a hydro-gel drainage in secondary glaucoma induced by silicone oil emulsification in patients after vitrectomy.
METHODS: The study included 35 eyes (35 patients) with secondary glaucoma induced by silicone oil emulsification after surgery for retinal detachment with silicone oil tamponade. Preoperative intraocular pressure ranged from 27 to 43 mmHg on maximum hypotensive regimen. All patients underwent a modified implantation of ExPRESS shunt and a hydrogel drainage. Ophthalmologic examination before and after surgery was supplemented by ultrasound biomicroscopy and optical coherence tomography of the anterior segment of the eye. All patients were examined on days 1, 7, 15 and 1, 3, 6, 12 and 18 months after the surgery.
RESULTS: All operations were carried out without complications. Signs of inflammatory reaction were observed in early postoperative period. Hyphema was detected in 5 cases (14%), choroidal detachment — in 2 cases (6%). In early postoperative period hypotensive effect was achieved in all cases. IOP level on the first postoperative day averaged 10.3±3.4 mm Hg. After 6 months of follow-up the average IOP level was 15.7±4.1 mm Hg. After 18 months mean IOP equaled 20.7±5.3 mm Hg, and hypotensive drops were appointed in 23 cases. According to optical coherence tomography data, the intrascleral cavity had a linear profile, with unclear borders and parietal inclusions (emulsified silicone). A thin hydrogel drainage was visualized in the cavity, along which the aqueous humor outflow and emulsified silicone.
CONCLUSION: Application of ExPRESS glaucoma filtration device combined with a hydro-gel drainage in secondary glaucoma induced by silicone emulsification in patients with operated retinal detachment allows to achieve a more stable and pronounced hypotensive effect compared to a separate implantation of ExPRESS glaucoma filtration device.
About the Authors
A. V. Sidorova
The S. Fedorov Eye Microsurgery State Institution
Russian Federation
Russian Federation
M.D., Ophthalmic surgeon, Head of Glaucoma Surgery Department,
59А Beskudnikovsky blv., Moscow, 127486
N. S. Khodjaev
The S. Fedorov Eye Microsurgery State Institution
Russian Federation
Russian Federation
M.D., Ph.D., Professor, Deputy Director,
59А Beskudnikovsky blv., Moscow, 127486
A. V. Starostina
The S. Fedorov Eye Microsurgery State Institution
Russian Federation
Russian Federation
Post-graduate student,
59А Beskudnikovsky blv., Moscow, 127486
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Review
For citations:
Sidorova A.V., Khodjaev N.S., Starostina A.V. The potential of ExPRESS Mini Glaucoma Shunt implantation in the treatment of secondary glaucoma induced by silicone oil emulsification in patients after vitrectomy. National Journal glaucoma. 2017;16(2):57-62. (In Russ.)
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