Exposure of Ex-PRESS Miniature Glaucoma Devices: case series and technique for tube shunt removal

To report a series of cases involving Ex-PRESS Miniature Glaucoma Device exposure and discuss the surgical techniques we used to remove the shunts.

A retrospective chart review was performed to identify all patients who were referred for Ex-PRESS Miniature Glaucoma Device exposure between January 2004 and December 2005. Demographic information, time to exposure, surgical technique for device implantation and removal, and patient outcomes after device removal were abstracted from the identified charts. In addition, we describe a surgical technique used to remove the exposed Ex-PRESS Miniature Glaucoma Devices.

Six patients (8 eyes) experienced Ex-PRESS Miniature Glaucoma Device exposure. The average time to exposure was 8.5 months. In 2 eyes, the shunt had been inserted under a half-thickness scleral flap; in both these eyes and 1 additional eye, Mitomycin-C had been used during shunt insertion. At presentation with tube shunt exposure, all eyes had normal or elevated intraocular pressure. In 5 eyes, visual acuity worsened after the device was removed. All 8 patients required concomitant glaucoma surgery with device removal.

As an increasing number of patients undergo filtration surgery with Ex-PRESS Miniature Glaucoma Devices, anterior segment surgeons should be aware of the potential for device exposure and methods for device removal.