Intermediate Outcomes of Mini Glaucoma Shunt Surgery Under Scleral Flap After Failed Canaloplasty

Friday, April 17, 2015
KIOSKS (San Diego Convention Center)
Evan J. Allan, MD
Kai Ding, PhD
Mahmoud Khaimi, MD
Justin Dvorak, BS

Some are apprehensive about utilizing canaloplasty given its use of conjunctiva and potentially higher risk of failure of subsequent filter. Our goal was to investigate the efficacy of Ex-PRESS shunt surgery after failed canaloplasty.

A retrospective review was performed of 20 consecutive eyes requiring filtration surgery after failed canaloplasty. All patients had open angles. The primary outcome measure was surgical success. Secondary outcomes included visual acuity, intraocular pressure (IOP), number of medications, and complications.

Mean follow-up time post-Ex-PRESS was 741 ± 334 days. Mean time from canaloplasty to Ex-PRESS shunt surgery was 250 +/- 135 days. Pre-operative IOP and number of medications were 31.7 +/-10.3 and 2.3 +/- 1.4, respectively. Surgical success at final follow-up was 75% with or without medications. At final follow-up, mean IOP and number of medications were 12.6 ± 5.4 and 0.8 +/- 1.1 . No major complications were reported.

Ex-PRESS shunt surgery after failed canaloplasty is efficacious and safe. Surgical success is similar to both tube versus trabeculectomy and primary Ex-PRESS shunt surgery data. Glaucoma specialists need not fear that good canaloplasty candidates will have worse outcomes should a subsequent filter be needed.