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Iris Fixation via External Pentagram Suturing

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ExPRESS Shunt Surgery for Glaucoma with Post-Traumatic Aniridia.

Valentín Huerva¹, M Carmen Sanchez, M Jesus Muniesa

¹Department of Ophthalmology, University Hospital Arnau of Vilanova , Lleida , Spain.

Seminars in Ophthalmology

|November 2, 2013

Summary

This study explores the Ex-PRESS implant for managing post-traumatic glaucoma in a patient with aphakia and aniridia. The implant effectively controlled intraocular pressure, preventing hypotony and choroidal detachment.

Keywords:

Ex-PRESS shunt surgery post-traumatic aniridia trabeculectomy traumatic glaucoma

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Area of Science:

Ophthalmology
Glaucoma Management
Ophthalmic Surgery

Background:

A 76-year-old male with post-traumatic aphakia and aniridia in his only right eye presented with uncontrolled intraocular pressure (IOP) despite maximal medical therapy.
The patient had elevated IOP of 24 mmHg and significant glaucomatous optic nerve damage (cup excavation 0.8).

Observation:

The Ex-PRESS implant was considered to prevent postoperative hypotony, a risk in patients with a single functioning eye.
Postoperative evaluation showed no Seidel's sign, hypotony, or choroidal detachment.

Findings:

Initial IOP was controlled at 14 mmHg for two months post-implantation.
IOP increased to 20 mmHg at three months, managed successfully with topical timolol and brimonidine.
IOP stabilized at 12 mmHg by the 10-month follow-up.

Implications:

The Ex-PRESS implant may be a viable surgical option for selected glaucoma patients with aphakia and aniridia, particularly those with a single functioning eye.
This case suggests the Ex-PRESS implant can be safely used to manage complex glaucoma cases, offering an alternative to traditional filtration surgery.
Further studies are warranted to evaluate the long-term efficacy and safety of the Ex-PRESS implant in similar patient populations.