Surgical treatment of neovascular glaucoma with Ex-PRESS glaucoma shunt

Abstract Purpose To compare the efficacy and safety profile of deep sclerectomy combined with Ex-PRESS shunt versus Ex-PRESS shunt surgery in eyes with neovascular glaucoma. Methods Twenty eyes with neovascular glaucoma secondery to proliferative diabetic retinopathy were included in our study. Panretinal photocoagulation and intravitreal bevacizumab injection were applied to these eyes. Despite full antiglaucomatous treatment and iris, angle neovascularization regression whose intraocular pressures were 21mm Hg and above were taken to surgery. Patients were randomly divided into two groups. Group A (10 patients) underwent deep sclerectomy combined with insertion of Ex-PRESS drainage device, group B (10 patients) underwent only Ex-PRESS glaucoma filtration surgery. Primary outcome measures were the intraocular pressure (IOP) and the number of antiglaucomatous medications at the first year follow-up visit. Results There was no difference in IOP between the groups at the first 2 month postoperatively (p>0.05). In the first 2 months, there was no need for antiglaucomatous medication in either group. In the third month, an antiglaucomatous drug was administered to 2 patients in group A and to 4 patients in group B. IOP values were lower in group A than group B at the third and sixth months (p<0.05). At the end of the first year, ≤18 mm Hg IOP rate was found 80% in group A and 60 in group B without medication. Conclusion Ex-PRESS shunt surgey demonstrated to be an effective treatment in eyes with neovascular glaucoma at the first year follow-up period. Ex-PRESS drainage device implantation with deep sclerectomy increased surgical success.