This is a brief video to show one technique for ab interno EX-PRESS Glaucoma Filtration Device removal through a clear corneal incision. Cataract surgery was completed first prior to turning attention to the EX-PRESS device. Inferonasal conjunctival cutdown was used for injection of lidocaine/bupivacaine at the start of the case. It is often desirable to avoid manipulating thin and scarred conjunctiva when performing various ocular surgical techniques and this is one example of how this can be completed.
Speaker: Dr. Malik Y. Kahook, Professor of Ophthalmology, University of Colorado, USA
This is Malik Kahook from the University of Colorado and I wanted to share a short video with you about AB interno explantation of an express glaucoma filtration device. This is a case of a 60 year old male who was six months status post Express glaucoma filtration device implantation at an outside facility, who presented to our clinics with visually significant cataract, membrane formation surrounding the anterior chamber portion of the Express device, flat blob with extremely thin and immobile conjunctiva and partial erosion of the Express faceplate into the Peripheral Cornea. Given this clinical presentation, the decision was made to perform cataract extraction with AB interno removal of the Express device to avoid the extremely thin and immobile conjunctiva. And then finally, to perform a goniotomy for control of intraocular pressure. This is going through a 2.4 millimeter temporal clear corneal incision to inject viscoelastic around the device making sure to separate the iris away from the posterior aspect of the device.
An MVR blade is then introduced into the anterior chamber through a paracentesis approximately 180 degrees away from the device. And the tip of the MVR blade is then used to peel away the membrane for 360 degrees around the device itself. Once that is accomplished, micro forceps are used to grab the device and pull it over the body of the iris followed by repositioning pulling the tip through the clear corneal incision. And then forceps are used to elevate the wound and remove the device from the anterior chamber. Goniotomy was then completed and the patient had an uneventful postoperative course. This is just a short video to show a case that is not commonly performed. I hope you enjoyed it. If you are interested in other educational resources, please consider visiting keogt.com, the YouTube channel that also has other educational videos, and you can connect with me on Twitter or Instagram. Thank you very much.