SAN FRANCISCO — Managing blebitis in patients with an Ex-Press mini glaucoma shunt implanted under a scleral flap does not call for removal of the device, a speaker said here.
Nor does the shunt need to be removed in cases of endophthalmitis, Steven R. Sarkisian Jr., MD, told colleagues at the American Glaucoma Society annual meeting.
Tens of thousands of Ex-Press (Alcon) mini glaucoma shunt devices have been implanted under a scleral flap in the past decade, and even though cases of blebitis have not been reported in the literature, they do occur, Sarkisian said.
"Blebitis can happen with the Ex-Press with mitomycin C just as it can with standard trabeculectomy with mitomycin C," he said.
In the largest cases series of the Ex-Press to date, 345 eyes and 3 years of follow-up, no cases of blebitis have been reported, he said. One case of endophthalmitis was reported in Ophthalmic Surgery, Lasers and Imaging, and vitreous tap and injection of intravitreal antibiotics were used to manage the case. Vitrectomy and removal of the shunt were not done, he said.
Many cases of blebitis happen many years after surgery, Sarkisian said.
"My management has been the same as if the patient had a standard trabeculectomy," he said, that is, topical antibiotics, vitreous tap and injection, or vitrectomy based on the severity of the case.
"I often consult my retina colleagues to assist in handling these cases. It is imperative that all bleb leaks be repaired in the usual fashion," Sarkisian said.
Ahmed Y, et al. Ophthalmic Surg Lasers Imaging. 2012;doi:10.3928/15428877-20120705-01.
Kanner EM, et al. J Glaucoma. 2009;doi:10.1097/IJG.0b013e31818fb44e.
Disclosure: Sarkisian is a consultant and speaker for Alcon.