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Nilforushan N, Abolfathzadeh N, Miraftabi A, Banifatemi M. Outcomes of Trabeculectomy and Ahmed Glaucoma Valve Implantation in Patients With Iridocorneal Endothelial Syndrome. J Glaucoma 2024; 33:e35-e42. [PMID: 38506803 DOI: 10.1097/ijg.0000000000002375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/28/2024] [Indexed: 03/21/2024]
Abstract
PRCIS Our study highlights the long-term success of trabeculectomy or Ahmed glaucoma valve (AGV) surgery in patients with glaucoma secondary to iridocorneal endothelial (ICE) syndrome. However, many ICE syndrome cases may need multiple glaucoma surgeries to achieve controlled intraocular pressure (IOP), with/without concomitant corneal graft surgery. OBJECTIVE To evaluate the long-term outcome of trabeculectomy and AGV implantation in ICE syndrome. METHODS Patients with glaucoma secondary to ICE syndrome who underwent either trabeculectomy or AGV surgery with intraoperative adjunctive mitomycin-C from 2009 to 2020 were included in this study. All patients were followed for at least 6 months after initial surgery. The main outcome measures were IOP, number of IOP-lowering medications, and surgical success. Surgical success was defined as complete according to the levels of IOP ( < 18) and at least 20% reduction from preoperative IOP without medications and qualified as a complete success but with medications, where the number of medications was less than preoperative numbers. Cumulative success was the sum of the qualified and complete success. RESULTS Twenty-nine eyes of 29 patients were included. Trabeculectomy was done in 13 patients (group A, 44.8%) and 16 patients underwent AGV surgery (group B, 55.2%). The median age was 50 (42-56.50) and 47 (36.75-52.75) years in groups A and B, respectively ( P = 0.10). All patients completed at least 2 years of follow-up. Mean IOP was not significantly different between groups preoperatively ( P = 0.70) and the effect of the type of surgery on IOP was not statistically significant at multiple follow-up time points (repeated measures analysis of variance, P = 0.44). The mean IOP decreased from 35.76 ± 6.36 mm Hg preoperatively to 16.00 ± 3.10 in group A and from 36.12 ± 8.11 mm Hg to 17.00 ± 3.75 in group B ( P = 0.449) at year 2 of follow-up. The effect of the type of surgery was not significant on the total number of IOP-lowering medications used throughout the study (repeated measures analysis of variance, P = 0.81). Kaplan-Meier analysis shows complete success in 14 patients (48.3%), 11 patients (37.9%), and 7 patients (24.1%) at 6-month, 1-year, and 2-year follow-up, respectively. The cumulative success rate was 95% at 2 years follow-up for all patients. CONCLUSIONS In 2-year follow-up, trabeculectomy or AGV significantly reduced the IOP in glaucoma patients secondary to ICE syndrome.
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Affiliation(s)
- Naveed Nilforushan
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Wajima R, Higashide T, Sugiyama K. Ex-PRESS shunt combined with ab-interno peripheral iridectomy: A new surgical procedure for iridocorneal endothelial syndrome. Am J Ophthalmol Case Rep 2023; 32:101887. [PMID: 38161521 PMCID: PMC10757185 DOI: 10.1016/j.ajoc.2023.101887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/15/2023] [Accepted: 07/02/2023] [Indexed: 01/03/2024] Open
Abstract
Purpose Iridocorneal endothelial (ICE) syndrome may cause refractory glaucoma due to progressive synechial closure or membrane formation at the anterior chamber angle. Filtration surgeries are often required but are associated with a higher rate of surgical failure or complications than other types of glaucoma. Herein, we report a new and effective surgical procedure for glaucoma secondary to ICE syndrome: Ex-PRESS shunt combined with ab-interno peripheral iridectomy using a small-gauge vitreous cutter. Methods Three patients with ICE syndrome who underwent surgery were included. Intraoperatively, an ab-interno peripheral iridectomy was performed using a small-gauge vitreous cutter through a corneal incision in the superior-nasal or superior-temporal quadrants to create space for the insertion of Ex-PRESS shunt free from the iris tissue. The shunt was inserted under the scleral flap. The first patient underwent combined cataract surgery, whereas patients 2 (pseudophakia) and 3 (phakia) underwent Ex-PRESS alone. Results No intraoperative complications were observed. The intraocular pressure remained stable until the final postoperative visits at approximately 7, 4, and 1 year in Cases 1, 2, and 3, respectively. Case 2, with mild preoperative corneal edema due to graft failure in Descemet's stripping automated endothelial keratoplasty (DSAEK), underwent reDSAEK 6 months postoperatively. Conclusions and importance Ex-PRESS shunt combined with ab-interno peripheral iridectomy using a small-gauge vitreous cutter may be a safe and effective surgical procedure in patients with ICE syndrome, regardless of the lens status.
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Affiliation(s)
- Ryotaro Wajima
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tomomi Higashide
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kazuhisa Sugiyama
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, 920-8641, Japan
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Josyula A, Mozzer A, Szeto J, Ha Y, Richmond N, Chung SW, Rompicharla SVK, Narayan J, Ramesh S, Hanes J, Ensign L, Parikh K, Pitha I. Nanofiber-based glaucoma drainage implant improves surgical outcomes by modulating fibroblast behavior. Bioeng Transl Med 2023; 8:e10487. [PMID: 37206200 PMCID: PMC10189467 DOI: 10.1002/btm2.10487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/01/2022] [Accepted: 12/19/2022] [Indexed: 11/02/2023] Open
Abstract
Biomaterials are implanted in millions of individuals worldwide each year. Both naturally derived and synthetic biomaterials induce a foreign body reaction that often culminates in fibrotic encapsulation and reduced functional lifespan. In ophthalmology, glaucoma drainage implants (GDIs) are implanted in the eye to reduce intraocular pressure (IOP) in order to prevent glaucoma progression and vision loss. Despite recent efforts towards miniaturization and surface chemistry modification, clinically available GDIs are susceptible to high rates of fibrosis and surgical failure. Here, we describe the development of synthetic, nanofiber-based GDIs with partially degradable inner cores. We evaluated GDIs with nanofiber or smooth surfaces to investigate the effect of surface topography on implant performance. We observed in vitro that nanofiber surfaces supported fibroblast integration and quiescence, even in the presence of pro-fibrotic signals, compared to smooth surfaces. In rabbit eyes, GDIs with a nanofiber architecture were biocompatible, prevented hypotony, and provided a volumetric aqueous outflow comparable to commercially available GDIs, though with significantly reduced fibrotic encapsulation and expression of key fibrotic markers in the surrounding tissue. We propose that the physical cues provided by the surface of the nanofiber-based GDIs mimic healthy extracellular matrix structure, mitigating fibroblast activation and potentially extending functional GDI lifespan.
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Affiliation(s)
- Aditya Josyula
- Center for NanomedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Chemical and Biomolecular EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Ann Mozzer
- Center for NanomedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Ophthalmology, Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Julia Szeto
- Center for NanomedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Ophthalmology, Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Youlim Ha
- Center for NanomedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Chemical and Biomolecular EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Nicole Richmond
- Center for NanomedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of BiologyJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Seung Woo Chung
- Center for NanomedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Ophthalmology, Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Sri Vishnu Kiran Rompicharla
- Center for NanomedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Ophthalmology, Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Janani Narayan
- Center for NanomedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Chemical and Biomolecular EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Samiksha Ramesh
- Center for NanomedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Justin Hanes
- Center for NanomedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Chemical and Biomolecular EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of Ophthalmology, Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Departments of Pharmacology and Molecular Sciences, Environmental Health Sciences, Oncology, and NeurosurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Laura Ensign
- Center for NanomedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Chemical and Biomolecular EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of Ophthalmology, Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Departments of Pharmacology and Molecular Sciences, Infectious Diseases, Oncology, and Gynecology and ObstetricsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Kunal Parikh
- Center for NanomedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Ophthalmology, Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Center for Bioengineering Innovation & DesignJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Ian Pitha
- Center for NanomedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Ophthalmology, Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Glaucoma Center of Excellence, Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Senthilkumar VA, Puthuran GV, Tara TD, Nagdev N, Ramesh S, Mani I, Krishnadas SR, Gedde SJ. Outcomes of the Aurolab aqueous drainage implant and trabeculectomy with mitomycin C in iridocorneal endothelial syndrome. Graefes Arch Clin Exp Ophthalmol 2023; 261:545-554. [PMID: 36038686 DOI: 10.1007/s00417-022-05811-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 07/24/2022] [Accepted: 08/16/2022] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To compare the surgical outcomes of the Aurolab aqueous drainage implant (AADI) and trabeculectomy with mitomycin C (MMC) in patients with glaucoma secondary to iridocorneal endothelial (ICE) syndrome. MATERIALS AND METHODS This retrospective comparative case series included 41 eyes of 41 patients with ICE syndrome and glaucoma who underwent either a trabeculectomy with MMC (n = 20) or AADI surgery (n = 21) with a minimum of 2 years follow-up. Outcome measures included intraocular pressure (IOP), the use of glaucoma medications, visual acuity, additional surgical interventions, and surgical complications. Surgical failure was defined as IOP > 21 mmHg or reduced < 20% from baseline, IOP ≤ 5 mmHg, reoperation for glaucoma or a complication, or loss of light perception vision. RESULTS The cumulative probability of failure at 2 years was 50% in the trabeculectomy group (95%CI = 31-83%) and 24% in the AADI group (95%CI = 11-48%) (p = 0.09). The IOP was consistently lower in the AADI group compared with the trabeculectomy group at 6 months and thereafter. Surgical complications occurred in 13 eyes (65%) in the trabeculectomy group and 12 eyes (57%) in the AADI group (p = 0.71). Reoperations for glaucoma or complications were performed in 12 eyes (60%) in the trabeculectomy group and 5 patients (24%) in the tube group (p = 0.06). Cox proportional hazards showed that AADI had a 53% lower risk of failure at 2 years (p = 0.18; HR = 0.47; 95%CI = 0.16-1.40). CONCLUSION AADI surgery achieved lower mean IOPs than trabeculectomy with MMC in managing glaucoma secondary to ICE syndrome. A trend toward lower rates of surgical failure and reoperations for glaucoma and complications was observed following AADI placement compared with trabeculectomy with MMC in eyes with ICE syndrome.
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Affiliation(s)
| | - George Varghese Puthuran
- Glaucoma Services, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Madurai, 625020, India.
| | - Techi Dodum Tara
- Glaucoma Services, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Madurai, 625020, India.,Glaucoma Services, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Tirunelveli, India
| | - Nimrita Nagdev
- Glaucoma Services, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Madurai, 625020, India
| | - Sujitha Ramesh
- Glaucoma Services, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Madurai, 625020, India
| | - Iswarya Mani
- Glaucoma Services, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Madurai, 625020, India
| | | | - Steven Jon Gedde
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL, USA
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Deng Y, Zhang S, Ye W, Gu J, Lin H, Cheng H, Xie Y, Le R, Tao Y, Zhang W, Chen W, Tham CC, He M, Wang N, Liang Y. Achieving inner aqueous drain in glaucoma secondary to iridocorneal endothelial syndrome: One year results of penetrating canaloplasty. Am J Ophthalmol 2022; 243:83-90. [PMID: 35870489 DOI: 10.1016/j.ajo.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 11/01/2022]
Abstract
PURPOSES To report the efficacy of a bleb-independent penetrating canaloplasty in the management of glaucoma secondary to iridocorneal endothelial syndrome (GS-ICE). DESIGN Prospective, non-comparative clinical study. METHODS Penetrating canaloplasty was performed on 35 eyes from 35 patients with GS-ICE and medically uncontrolled IOP between January 2018 and April 2020. Patients were followed up at one week, month 1, 3, 6, 12 postoperatively, and semi-annually thereafter. Intraocular pressure (IOP), number of anti-glaucoma medication and surgery-related complications were recorded. Surgical success was defined as IOP ≥5 and ≤21mmHg without (complete success) or with/without (qualified success) IOP-lowering medications. RESULTS A total of 29 eyes (82.9%) had 360° catheterization and successfully received penetrating canaloplasty. Of these eyes, 24 (82.8%) achieved qualified success and 22 (75.9%) achieved qualified success at 12 months after surgery. The mean IOP decreased from 39.5±11.8 mmHg on 2.9±1.0 medications before surgery to 16.6±5.3 mmHg (P<0.001) on 0.2±0.6 medications (P<0.001) at 12 months post-operation, respectively. Hyphema (37.9%), transient hypotony (34.5%) and transient post-operative IOP elevation (≥30mmHg, 17.9%) were the most commonly observed early complications at the one week and one month visits. From one month and beyond, all treated eyes showed no obvious bleb at the operation quadrant. CONCLUSIONS Penetrating canaloplasty rescued the inner aqueous outflow in ICE eyes and demonstrated quite acceptable success in IOP control with few complications, providing a new option for the management of GS-ICE.
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Affiliation(s)
- Yuxuan Deng
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China; Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Shaodan Zhang
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Wenqing Ye
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Juan Gu
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Haishuang Lin
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Huanhuan Cheng
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China; Wuhu First People's Hospital, Wuhu, Anhui, China
| | - Yanqian Xie
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Rongrong Le
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Yan Tao
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Wei Zhang
- Biomedical Informatics and Statistics Center, School of Public Health, Fudan University, Shanghai, China
| | - Wei Chen
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mingguang He
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | | | - Yuanbo Liang
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China.
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Rodrigo-Rey S, Bolívar G, Paz J, Teus MÁ. Ex-PRESS® implant as the first surgical option in the iridocorneal endothelial syndrome. ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA 2021; 96:430-433. [PMID: 34340781 DOI: 10.1016/j.oftale.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 12/15/2020] [Indexed: 12/17/2022]
Abstract
Our purpose is to report the intermediate-term results of the Ex-PRESS® implant as the first surgical option in patients with Iridocorneal Endothelial (ICE) Syndrome. We describe two patients diagnosed from ICE syndrome with medically uncontrolled glaucoma and finally treated with an Ex-PRESS® implant, associating a cataract surgery in one of them. Three years after surgery, intraocular pressure remains stable without any additional medical antiglaucomatous treatment, with a well-located implant surrounded by a diffuse filtering bleb and no sight-threatening adverse events have been documented. In addition, no progression of the disease has been registered. This report encourage the Ex-PRESS® implant to be considered the first surgical option in this patients as it allows a permeable ostium in spite of the progressive synechial angle closure typical of the ICE syndrome.
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Affiliation(s)
- S Rodrigo-Rey
- Ophthalmology Department, Universitary Hospital «Príncipe de Asturias», Alcalá de Henares, Madrid, Spain.
| | - G Bolívar
- Ophthalmology Department, Universitary Hospital «Príncipe de Asturias», Alcalá de Henares, Madrid, Spain
| | - J Paz
- Ophthalmology Department, Universitary Hospital «Príncipe de Asturias», Alcalá de Henares, Madrid, Spain
| | - M Á Teus
- Ophthalmology Department, Universitary Hospital «Príncipe de Asturias», Alcalá de Henares, Madrid, Spain; University of Alcalá, School of Medicine, Alcalá de Henares, Madrid, Spain
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Abstract
Our purpose is to report the intermediate-term results of the Ex-PRESS® implant as the first surgical option in patients with Iridocorneal Endothelial (ICE) Syndrome. We describe two patients diagnosed from ICE syndrome with medically uncontrolled glaucoma and finally treated with an Ex-PRESS® implant, associating a cataract surgery in one of them. Three years after surgery, intraocular pressure remains stable without any additional medical antiglaucomatous treatment, with a well-located implant surrounded by a diffuse filtering bleb and no sight-threatening adverse events have been documented. In addition, no progression of the disease has been registered. This report encourage the Ex-PRESS® implant to be considered the first surgical option in this patients as it allows a permeable ostium in spite of the progressive synechial angle closure typical of the ICE syndrome.
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