الفهرس 
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Abstract
Conclusion
Patients with refractory glaucoma are unresponsive to routine treatment, including medical treatment for lowering IOP and traditional surgical procedures. Most cases of refractory glaucoma consist of secondary glaucoma with complex features, including very high IOP, various and/or unknown mechanisms for elevated IOP, limited assessment and treatment due to perplexing ocular factors, higher fibrotic response in these eyes, the need for combination therapies, poor prognosis, and rapid deterioration in vision.
It is likely that GDDs are preferable for a secondary procedure after failed trabeculectomy. Stable filtration after Ex-PRESS implantation may be expected to show less IOP fluctuation during the intraoperative and early postoperative periods. Despite that previous studies reported that Ex-PRESS implantation is undoubtedly effective treatment methods for refractory glaucoma, compared with the drug and laser therapy. Our results of Ex-PRESS in eyes with refractory glaucoma are quite encouraging.
Ex-PRESS shunt’s markedly higher cost will be a major limitation in its adoption into clinical practice. However; the cost of Ex-PRESS might be outweighed by its benefits in terms of lower complication rates, lower postoperative intervention rates, and above all, its higher complete success rate that relieves patients from the costs of postoperative anti-glaucoma medications. It’s preferred to use Ex-PRESS device implantation in refractory glaucoma.
Summary
Glaucoma is the leading cause of irreversible blindness worldwide. The actual problem is the treatment of glaucoma refractory to medical treatment, laser and filtering operations. Refractory glaucoma patients include those with a previous failed trabeculectomy, NVG, UG, aphakic and pseudophakic glaucoma. One of the surgical treatments for refractory glaucoma is GDD implantation such as Ex-PRESS device. The Ex-PRESS device is a unique valveless stainless steel tube, which is implanted under scleral flap, causing bleb formation around the flap.
In this study, we evaluated the role of the Ex-PRESS device implantation in the management of refractory glaucoma. Our study included 20 patients (28 eyes) with refractory glaucoma who were scheduled to undergo Ex-PRESS glaucoma filtration device due to high risk of surgical failure of conventional trabeculectomy. Three eyes were excluded due to operative complications.
Our results demonstrated that there is a high probability of success following Ex-PRESS implantation. There is a significant IOP reduction and significant improvement in BCVA, VF and OCT parameters and endothelial CD. As the complete success rate one year after Ex-PRESS implantation was 48% and the qualified success rate was 52% one year after Ex-PRESS implantation.
However, Ex-PRESS shunt’s markedly higher cost may cause limitations in its adoption into clinical practice. On the other hand, the cost of Ex-PRESS may be outweighed by its benefits in terms of lower complication rates, lower postoperative intervention rates, and above all, its higher complete success rate that relieves patients from the costs of postoperative anti-glaucoma medications. It’s preferred to use Ex-PRESS device implantation in refractory glaucoma.