Displacement of Ex-PRESS Shunt Head Outside the Conjunctiva in a Uveitis Patient: A Case Report

Case Report

Austin Ophthalmol. 2021; 5(3): 1028.

Displacement of Ex-PRESS Shunt Head Outside the Conjunctiva in a Uveitis Patient: A Case Report

Mohamed Osman¹, Ehab Y Alsirhy², Sulaiman M Altariqi² and Essam A Osman²*

¹Department of Urgent and Emergency Care, Rotherham General Hospital, Rotherham, UK

²Department of Ophthalmology, King Abdulaziz University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia

*Corresponding author: Essam A Osman, Department of Ophthalmology, King Abdulaziz University Hospital, King Saud University Medical City, PO Box 245, Riyadh, 11411, Saudi Arabia

Received: September 24, 2021; Accepted: October 14, 2021; Published: October 21, 2021

Abstract

Ex-PRESS mini shunt is recently involved in trabeculectomy surgery with a good outcome. We present a 14-year-old male with a history of juvenile idiopathic arthritis, non-granulomatous anterior uveitis, and secondary glaucoma operated with trabeculectomy Ex-PRESS shunt in his right eye. The patient developed extrusion of the implant head outside the conjunctiva after 4 years of surgery. The patient admitted to the hospital with removal of Ex-PRESS shunt under general anesthesia with the suturing of the scleral defect and closure of the conjunctiva.

Keywords: Uveitis; Glaucoma; Ex-PRESS Mini Shunt

Introduction

Glaucoma filtration surgery is designated to reduce Intraocular Pressure (IOP) when maximal medical therapy fails to lower IOP sufficiently and prevent optic nerve damage [1]. Trabeculectomy surgery is the most common procedure for glaucoma filtration surgery since 1968 [2]. The placement of the Ex-PRESS glaucoma filtration device (Alcon, Fort Worth, TX) under a partial thickness scleral flap is one of the adjustments of glaucoma filtration surgery. The Ex-PRESS glaucoma filtration device is stainless steel (biocompatible, magnetic resonance imaging-compatible) non-valved device that shifts aqueous humor from the anterior chamber to the subconjunctival space and forms a filtration bleb, as seen in standard trabeculectomy [3]. The Ex-PRESS device eradicates the need for both peripheral iridectomy and removal of a deep corneoscleral tissue block compared with trabeculectomy, but these rewards require aligning the device properly to avoid contact with either the cornea or the iris. Evidence suggests that adding trabeculectomy using the Ex-PRESS device leads to a lower complication rate and a faster visual recovery [4]. We present a rare complication of displacement of the Ex-PRESS shunt head outside the conjunctiva with successful removal and wound closure without complications.

Case Presentation

A 14-year-old male with juvenile idiopathic arthritis and nongranulomatous anterior uveitis under treatment of mycophenolate mofetil and Prednisolone eye drops. The patient developed secondary angle-closure glaucoma in both eyes with Intraocular Pressure (IOP) of 41mmHg right eye and 24mmHg left eye, treated medically by combined Dorzolamide and Timolol eye drops. The history of this patient started in January 2015, his visual acuity was counting fingers (CF) right eye and 20/200 left eye, posterior subcapsular cataract both eyes, posterior synechiae and no fundus view (Figure 1).