Clinical Ophthalmology (Jan 2023)
Modified Technique of Ex-PRESS® Filtration Device Combined with a Scleral Pocket for Hereditary Transthyretin Amyloidosis (hATTR) Secondary Open-Angle Glaucoma
Abstract
Rita Vieira,1 Ana Marta,1,2 André Ferreira,1,3 Ana Figueiredo,1 Rita Falcão Reis,1 Isabel Sampaio,1 Maria João Menéres1,2 1Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal; 2Ophthalmology Teaching Department, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Oporto, Portugal; 3Anamoty Department of Faculdade de Medicina da Universidade do Porto (FMUP), Oporto, PortugalCorrespondence: Rita Vieira, Ophthalmology Department, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, Porto, 4099-001, Portugal, Tel +351913748812, Email [email protected]: To evaluate the effectiveness and safety of a modified approach using the Ex-PRESS® 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® 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.Keywords: amyloidosis, FAP glaucoma, hereditary transthyretin amyloidosis, hATTR
