Técnica Modificada com o Dispositivo Ex-PRESS® Combinada com um Bolso Escleral Versus Válvula de Ahmed no Glaucoma por Amiloidose Hereditária por Transtirretina: Um Estudo Comparativo

INTRODUCTION: Our purpose was to analyze and compare the efficacy and safety of two surgical procedures: an Ex-PRESS® modified technique versus Ahmed glaucoma valve (AGV) in the management of hereditary transthyretin amyloidosis (hTTRA) secondary open-angle glaucoma in our tertiary center. METHODS: Retrospective, comparative study. The main outcomes were intraocular pressure (IOP) evaluation (baseline, 1st day, 1st week, 1, 3, 6 and 12 months) and number of hypotensive drugs (baseline, 6th and 12th months). As secondary outcomes, surgical complications, need for additional glaucoma surgery, optic disc retinal nerve fiber layer thickness (OD-RNFL), endothelial cell count (ECC) and LogMAR BCVA were evaluated. Complete surgical success was defined as unmedicated IOP ≤ 18 mmHg. The minimum follow-up was 12 months. RESULTS: A total of 156 eyes were included: 32 eyes (20.5%) were submitted to the ExPRESS® modified technique (group 1) and 124 eyes (79.5%) were submitted to an AGV implant (group 2). Intra-ocular pressure decreased significantly from baseline (group 1: 27.4±4.4 mmHg; group 2: 28.4±6.9 mmHg, p=0.411) until month 12 (group 1: 12.0±3.5 mmHg; group 2: 13.1±6.8 mmHg, p=0.013) in both groups, being statistically lower in eyes from group 1 (p=0.012). There was also a significant reduction in the number of antiglaucoma medications from baseline (group 1: 3.8±0.6; group 2: 3.9±0.7, p=0.211) and 12th month (group 1: 0.4±0.8; group 2: 1.8±1.5, p<0.001), with group 1 exhibiting a significantly lower number of hypotensive drugs (p<0.001). LogMAR BCVA remained stable from baseline (group 1: 0.25±0.26; group 2: 0.26±0.30, p=0.458), to 12th month (0.25±0.24; group 2: 0.23±0.29, p=0.874). Transient hypotony was higher in group 1 (17 eyes, 53.1% versus 8 eyes from group 2, 6.5%), X=37.06, p<0.001. Four eyes from group 1 (12.5%) and 7 eyes from group 2 (5.6%) needed an additional glaucoma surgery (X² Fisher exact test p=0.104). Complete surgical success was higher in eyes from group 1 (22 eyes-68.8%, versus 29 eyes-23.4%), p<0.001. CONCLUSION: Although both procedures showed significant IOP reduction, ExPRESS® modified technique seems to be more effective when a lower IOP is needed. Also, with this novel technique a lower number of antiglaucomatous medications was necessary. On the other hand, hypotony was more frequent with the ExPRESS® modified technique.