Modified Technique of Ex-PRESS (R) Filtration Device Combined with a Scleral Pocket for Hereditary Transthyretin Amyloidosis (hATTR) Secondary Open-Angle Glaucoma

• Type: Article in International Scientific Journal
• Date: 2023

Authors

Vieira, R (Author) Other; Marta, A (Author) Other; Ferreira, A (Author) FMUP; Figueiredo, A (Author) Other; Reis, RF (Author) Other; Sampaio, I (Author) Other; Meneres, MJ (Author) Other

Journal

Title: Clinical Ophthalmology

Vol. 17

Pages: 403-411

ISSN: 1177-5467

Publisher: Dove Medical Press

Indexing

ISI Web of Knowledge - 0 Citations

Scopus

Other information

Authenticus ID: P-00Y-13T

DOI: 10.2147/opth.s394360

Abstract (EN): Purpose: To evaluate the effectiveness and safety of a modified approach using the Ex-PRESS (R) implant combined with a scleral pocket in the management of secondary open-angle glaucoma in hereditary transthyretin amyloidosis (hATTR) at our department.Methods: This was a retrospective analysis. The primary endpoints included Intraocular pressure (IOP) evaluation (baseline, 1st day, 1st week, 1, 3, 6, 12 months and at last follow-up) and number of hypotensive drugs (baseline, 6th, 12th months and at last follow-up). As secondary endpoints surgical complications, the need for additional glaucoma surgery and LogMAR BCVA were evaluated. Qualified and complete success were defined as >= 30% IOP decrease from baseline, with or without additional medications, respectively. The minimum follow-up was 12 months.Results: A total of 32 eyes were included with a mean follow-up of 2.4 +/- 2.9 years. IOP decreased significantly from baseline (27.4 +/- 4.4 mmHg) to 1st day (5.00 +/- 2.9 mmHg), 1st week (6.9 +/- 4.1 mmHg), 1st month (11.7 +/- 7.8 mmHg), 3rd month (11.6 +/- 6.1 mmHg), 6th month (13.1 +/- 6.8 mmHg), 12th month (12.0 +/- 3.5 mmHg) and last visit (11.8 +/- 2.4 mmHg), p<0.001. There was also a significant reduction in the number of antiglaucoma medications from baseline (3.8 +/- 0.6) and last follow-up (0.4 +/- 0.8), p<0.001. LogMAR BCVA remained stable (0.25 +/- 0.26 at baseline and 0.25 +/- 0.24 at last follow-up), p=0.767. Transient hypotony occurred in 17 eyes (53.1%), but only 11 (34.4%) exhibited anterior chamber shallowing and needed additional care, namely cycloplegic drops and viscoelastic injection. Complete surgical success was achieved in 22 eyes (68.8%) and qualified success in 6 eyes (18.8%). Four eyes (12.5%) needed additional glaucoma surgery.Conclusion: The modified ExPRESS (R) technique appears to be effective, especially when low levels of IOP are required. Additionally, fewer anti-glaucoma drugs were necessary. In the other hand, hypotony was a common side effect with this procedure, although all patients were properly handled, preserving the surgical outcomes.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 9