Neodymium laser treatment effective for IOP rise after Ex-Press implantation

This study examined the use of neodymium laser in eyes with high IOP following Ex-Press filtration device implantation. 

Study design

The authors retrospectively studied 53 patients seen at 4 institutions who underwent Ex-Press (Alcon) implantation with subsequent development of IOP rise. Patients were treated with neodymium laser at the axial and relief ports of the Ex-Press device. All patients included in the study had a diagnosis of primary open-angle glaucoma, IOP above target and a flat bleb. Success was defined as IOP of 18 mm Hg or less at 6 months without further surgical or laser intervention.

Outcomes

All eyes had a statistically significant decrease in IOP immediately post-treatment. Of the 43 eyes with 6 months of follow-up, 11 eyes required further glaucoma surgery or laser. Four eyes had an IOP of 18 mm Hg or greater. The remaining 28 eyes were deemed a success at 6 months.

Three eyes developed hypotony (IOP<5 mm Hg), all resolved by 1-week post-laser. One eye had a decrease in Snellen acuity of at least 2 lines. No patient reported pain. There was no statistically significant change in number of medications among the remaining 32 eyes that did not require additional surgical or laser intervention.

Limitations

The inclusion of only primary open-angle eyes limits the applicability of this study to other secondary glaucomas. Short follow-up limits conclusions about long-term success.

Clinical significance

Neodymium laser application to the axial and relief ports of the Ex-Press device is a low risk and effective method of lowering IOP in patients with a flat bleb and IOP above target, even in the absence of visible obstruction of the device lumen. This could be considered first line treatment before further medical, laser, or surgical interventions are pursued.