Efficacy and Safety of the Ex-PRESS Glaucoma Mini-Shunt with Intraoperative 5-Fluorouracil ASCRS 2009 San Francisco A. Balashanmugam, MD, L. Farrokh-Siar, MD, University Eye Specialists Chicago, IL Authors have no financial interest Introduction The Ex-PRESS TM glaucoma mini-shunt was designed for implantation under a partial-thickness scleral flap for patients with open angle glaucoma. In a prior study, the Ex-PRESS was found to have comparable efficacy, with a lower rate of hypotony, in comparison to trabeculectomy (1). A recent case series of Ex-PRESS followed for 3 years reported a high rate of success and a low rate of complication (2). 1.P. J. G. Maris, K Ishida, P A Netland. Comparison of Trabeculectomy with Ex-PRESS Miniature Glaucoma Device Implanted Under Scleral Flap. J Glaucoma Jan; 16: E. Kanner, P.A Netland, S.R Sarkisian, H.Du. Ex-PRESS Miniature Glaucoma Device Implanted Under a Scleral Flap Alone or Combined With Phacoemulsification Cataract Surgery. J. Glaucoma Feb 2009 (Epub ahead of print) Introduction The use of antimetabolites has greatly increased success rates of glaucoma filtering surgery. 5-Fluorouracil (5-FU) was introduced in 1984 and has been gaining popularity in clinical use (1). Both of the studies listed previously have looked at the outcome of the Ex-PRESS mini-shunt in conjunction with the use of intraoperative Mitomycin C. 1)D. Wudunn, L.B Cantor. A Prospective Randomized Trial Comparing Intraoperative 5-Fluorouracil vs Mitomycin C in Primary Trabeculectomy. Am J Ophthalmol 2002;134: 521 Fluorouracil Purpose To report the efficacy and safety of the Ex-PRESS glaucoma mini-shunt implantation under a partial thickness scleral flap, using intraoperative and supplemental postoperative 5-FU, in a population of African American patients with medically uncontrolled glaucoma. Post-operative 5FU injections 5-Fluorouracil Patient Demographics N = 14 eyes (11 patients) Age : 71 9.8 (range 46-81) years Gender : Male 6 (55 %) Female 5 (45%) Race : African American 11/11 Lens Status: Phakic -12 (86%) Pseudophakic 2 (14%) Glaucoma type : OAG 12 (86%) ACG -- 1 (7%) Traumatic glaucoma 1 (7%) Follow-up : 9.1 4.9 (range 1-18) months Methods All eyes underwent Ex-PRESS implantation under a partial-thickness scleral flap with intraoperative 5-FU (50 mg/ml for 3 min). Postoperative 5-FU injections were given as required. All surgeries were performed by a single surgeon (LFS). Ex-PRESS under scleral flap Intraoperative 5-FUPost-op 5FU injections Stainless steel miniature glaucoma device with good biocompatibility (1) Device length 2.64mm External lumen size - 400m Internal lumen size 50m Device Description 1. A Nyska, Y. Glovinsky, M. Belkin, and Y. Epstein. Biocompatibility of the Ex-PRESS miniature glaucoma drainage implant. J Glaucoma Jun; 12(3): Ex-PRESS P model specifications Results Outcomes measures: IOP Medications Complications Patients received an average of 3.8 3.0 (range 1-13) postoperative 5-FU injections (0.1ml of 50mg/ml). Ex-PRESS: Day 1 post op Results - IOP Mean IOP: Decreased from 33.6 9.4mmHg to 13.3 3.7 mmHg at last visit (p=0.0002). Results Medication Need Mean # of anti-glaucoma meds: Decreased from 4.4 0.6 to 0.4 1.1 at the last visit (p=0.000). Complications Choroidal effusion 2 (14.3%) Flat AC 1 (7.1 %) Surgical revision - 2 (14.3%) No erosion or blockage of shunt, endophthalmitis or corneal decompensation observed Conclusion Implantation of the Ex-PRESS TM glaucoma mini-shunt with intraoperative (and supplemental postoperative) 5-FU was effective in lowering IOP in this series of African American patients with uncontrolled glaucoma. A relatively low rate of complications was noted in this case series. The use of 5-FU provides a safe alternative to Mitomycin C, and should be considered for antifibrotic use in Ex-PRESS implantation.