Ex-PRESS Mini Glaucoma Shunt implantation represents the latest breakthrough in glaucoma filtration surgery. Smaller than a grain of rice the Ex-PRESS is the world’s first minature glaucoma shunt providing treatment for patients suffering from open angle glaucoma. It is a less invasive alternative to trabeculectomy to reduce intraocular pressure (IOP).
Traditionally, glaucoma is first treated by administration of eye drops. If the eye drops are not effective, laser procedures may be performed to open the drain if your doctor thinks this is appropriate. If laser is ineffective, or not appropriate for your type or level of glaucoma, a filtering procedure such as the Ex-PRESS mini shunt implantation may be needed to preserve your vision.
Since only the symptoms of glaucoma can be treated, glaucoma cannot be cured. The Ex-PRESS mini glaucoma shunt treats the symptoms of glaucoma and prevents a further deterioration in vision. However, previous damage to your sight cannot be reversed.
The pressure-lowering effect of the Ex-PRESS is immediate. You might be able to return to work within 2-7 days after the procedure; however, this will vary. Please advise your doctor for further information.
The Ex-PRESS shunt starts to work immediately. During the first 4 weeks, the eye pressure is stabilized to new levels. In most cases, after that time, your eye pressure will be maintained. Your vision will be back to normal shortly after the procedure.
The Ex-PRESS is manufactured from stainless steel which is commonly used in human implantations including cardiac stents. The Ex-PRESS has been proven to be biocompatible and MRI safe.
Most patients, after Ex-PRESS implantation, don’t need their glaucoma medications anymore since the Ex-PRESS is very effective at lowering the inner eye pressure. However, your doctor may recommend medications at some point after the surgery if your glaucoma is very severe.
The Ex-PRESS mini glaucoma shunt implantation has a high success rate at lowering intraocular pressure (IOP). This mini glaucoma shunt has fewer complications compared with standardized trabeculectomy. The Ex-PRESS can be used in combination with a cataract surgery.
Since local anesthesia is used during surgery, there is virtually no pain involved. After surgery, if any discomfort is felt, Tylenol can be used. Most of the discomfort is associated with the dissolvable sutures used to close the conjunctiva, which is the thin layer of “skin” that covers the eyeball. Careful compliance with the medications prescribed after the surgery should help alleviate this discomfort until the sutures dissolve.
The Ex-PRESS is a highly successful and effective procedure. The success rates stand at around 90%. This is comparatively high to other traditional procedures.
No special preparation is needed. You may be required to stop any medicines you take that thin you blood (for example, Coumadin, Plavix, or Aspirin). Please consult your doctor for more information.
The complications are similar to other intraocular procedures, but they were found to be less frequent with the Ex-PRESS mini shunt. The risks involved with any intraocular surgery are namely inflammation, infection, bleeding, and decrease in vision, although with the Ex-PRESS mini shunt these risks may be reduced compared to traditional glaucoma surgery.
Usually, just as with other inner eye procedures, the follow up appointments are typically on the first day after surgery, the first week and the first month. After that, every 3rd month follow up is recommended. Your doctor may recommend more frequent visits depending his/her usual practice and other factors that may arise after your surgery.
The Ex-PRESS mini shunt is a relatively new device, available in the USA since 2002. Over 12,000 implantations have been performed worldwide. It is a straightforward procedure, in which you divert the fluid from the inside of the eye through an extremely small tube to the outside of the eye. Although the device is as small as a grain of rice, it acts just like a heart stent keeping a pathway open so fluid can successfully go around the blockage. The Ex-PRESS provides precise control of the amount of fluid that is allowed to flow out helping the eye maintain a healthy level of internal pressure.
The Ex-PRESS mini glaucoma shunt provides effective long term control of intraocular pressure, with a success rate of about 94% 1. It can be done following cataract surgery.
The Ex-PRESS has an equally effective intraocular pressure control compared with trabeculectomy, but is safer than trabeculectomy in the short term 2.
In most cases, patients virtually eliminate their need for glaucoma eye drops after Ex-PRESS surgery.