Glaucoma Ex-Press

Something worth seeing: A surgical procedure using the Ex-Press method for the treatment of Glaucoma has recently been introduced in the Hillel Yaffe Medical Centre by the newly appointed Head of Ophthalmology, Dr. Beatrice Tiosano. With her specialization in glaucoma surgery and her rich experience in the above method, Dr. Tiosano is among the pioneers of this procedure in Israel.

Information about glaucoma
Glaucoma” or as it is medically defined “ocular hypertension”, is a common disease which affects approximately 0.5% of those aged 50+, and 3% of those over 75 years of age, and causes damage to the fibers of the optic nerve. Glaucoma is a chronic disease which usually affects both eyes  and as it progresses its symptoms  and damage become more severe, leading to gradual field vision loss. In most cases the patient suffers no pain and does not notice any loss of vision (as a result of an automatic adjustment, made by the patient, of shifting the head in the direction of vision loss), so that the majority of patients seek treatment only after severe damage has already been done.

Consequently everyone over the age of 50 is advised to undergo an intraocular pressure (IOP) examination by an ophthalmologist, and in cases where there is a family history of the disease, an examination should be done even before this age.

The major cause of the disease is ocular hypertension, therefore the objective of existing treatments for glaucoma is to reduce this pressure, and to try to protect the optic nerve. If the disease is diagnosed in time, it can be controlled by medication or local adjustments with laser treatment. In some cases, however, if the pressure is not balanced, corrective surgery may be required.

Treatments and surgeries
“The most common conventional surgical procedure for glaucoma is a Trabeculectomy”, says Dr.Tiosano. “In this procedure the surgeon creates an opening for drainage in the scleral wall of the eye, and in some cases a portion of the trabecular meshwork is removed. One of the most advanced techniques nowadays includes the insertion of a miniscule Ex-Press implant in the eye, without removing tissue from the wall of the eye. This implant allows for drainage of excess fluid from the eye, as well as maintaining balanced pressure. The drain is made of stainless steel, and is implanted under the sclera, located above the iris, using a unique surgical procedure performed under local anesthetics”.

Dr. Tiosano, who has been performing glaucoma surgery for many years, is one of the leading doctors to introduce the Ex-Press technique and the use of the implant and drain.  Over the last few years, since the use of this technique was approved in Israel, Dr.Tiosano has performed over 100 surgical procedures using this method.

  Dr. Tiosano in the operating room 

“It must be noted that both according to studies conducted overseas, as well as long-term observations  on patients here in Israel, we have clear evidence of the advantages of this treatment in comparison with the conventional methods of treatment. The advantages include quicker recovery, lower frequency of excessive drainage, which leads to exaggerated reduction of intraocular pressure (hypotonia), better long term results in maintaining normal intraocular pressure, together with a reduction in the necessity for medication for intraocular pressure in the years after surgery.  After considering the above advantages, the Health Basket Committee for 2010 approved this surgical procedure for patients whose trabeculectomy was unsuccessful at least once, for patients with cataract who were on the list for combined surgery for cataract and glaucoma, as well as those who had already received maximum medication or who were unable to receive the maximum level of medication.

“The decision regarding performing the surgery with this method is made by the medical team who are treating the patient”, concludes Dr. Tiosano. “However, in view of the promising results, this method of surgery is now used much more frequently. I am pleased that we, at Hillel Yaffe, are now able to offer the procedure to any patient who requires it”.