Is ExPRESS Shunt Just Hype?
March 8, 2009
I fail to understand the advantage of the ExPRESS shunt. One still has to perform all the steps of a traditional trabeculectomy (except for excising a piece of the trabecular tissue, which is the easiest part of the surgery anyway), including a scleral flap, conjunctival dissection and the creation of a bleb. And since the vast majority of failures in trabs are related to scar tissue in the conjunctiva, I don’t see how the shunt would increase the success rate, as it would have no effect on that. We need a procedure which doesn’t require a bleb and has a low complication rate.
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I have posted on the Avastin blog, for a friend. He received Avasitin due to a CRVO. He also has glaucoma. A week before the shot, his IOP had risen to 17, from a target of 12 (this was at the time the CRVO was diagnosed).
A week later, his affected eye started to ache, and ihis IOP was measured at 30. Avastin was given at that time.
The next day, the eye was hurting more and IOP had risen to 57. They gave him a diuretic and before he left, it was down to 40.
They advised him, and have him scheduled for a valve shunt procedure.
I am concerned after reading here, about complications and whether or not a trab would be enough.
Thoughts? And thank you for this website.
Annette
sounds like the patient has neovascular glaucoma due to the crvo. avastin is the treatment of choice, and failing that, a valve is best, not a trab. from what you write here, i agree with their management.