Glaucoma Surgery – Ex-Press Mini Glaucoma Shunt
Why is this eye surgery done?
Ex-Press mini glaucoma shunt is used in the treatment of glaucoma to lower the
pressure in the eye. Often this is done when medications have not lowered your eye
pressure to a safe level. If the pressure remains too high, it can permanently damage
the optic nerve and your vision.
What is done?
A small opening is made in the white sclera of the eye to create a drainage channel
for fluid from the inside of the eye. The Ex-Press mini-shunt is inserted into the
opening. The area is covered by a thin tissue, the conjunctiva. When the fluid
flows through this shunt, it collects under the conjunctiva and forms a bleb or small
blister. The fluid under the bleb is slowly absorbed by the body. Doctors look for
the bleb to be sure that the fluid is draining the way it should.
Shunt is placed here
Will this work?
Glaucoma surgery is usually successful, approximately 80-85% if the time. Over
time, your body may try to close the new hole. Sometimes drugs (5-Fluorouracil
and Mitomycin-C) can be used during or after the surgery to prevent scar tissue
from forming. Most of the time Mitomycin-C is used during the surgery and
sometimes 5-Fluorouracil is used after the surgery. The doctor will help you decide
whether this is needed. This will depend on your age, if you have had eye surgery in
the past, and what type of glaucoma you have.
After five years, about 50% of patients have eye pressures low enough that they do
not need glaucoma drops to maintain good pressure. About 25% will need to use
drugs, and 25% of patients will have pressure over their target even with the shunt
and eye drops. We can prevent further loss of vision 65% to 90% of the time.
What Are the Risks?
The most common risks of surgery are that the new drain works too little or too
well. If the eye has heavy scarring and the drain works too little, the pressure in the
eye remains too high and drugs are needed to lower the pressure. If the new drain
works too well, sometimes the eye pressure gets so low that fluid may build up
behind the inner lining of the eye (retina) and may cause a temporary loss of vision.
You may need a second surgery to refill the eye with fluid.
For a short time after the surgery, you will likely have some blurriness of vision.
In rare cases, loss of vision may be permanent. There is a very rare risk of losing
your eye or dying during surgery.
How do I get ready?
To be sure that you are healthy enough for the surgery, you will need a physical
exam. We will arrange this appointment for you. It may include blood tests, an
EKG (heart tracing) and chest x-ray.
You may need to stop taking aspirin, blood thinners, ibuprofen, anti-inflammatory
arthritis medicines, or cold products with ibuprofen or aspirin one week before the
surgery, as they can cause bleeding. Patients who take these or other blood thinners
for health reasons should check with their own doctors before stopping them.
A nurse will call you the day before surgery to tell you what time to arrive, and to
tell you what you need to do to get ready.
How is Ex-Press mini-shunt done?
Plan to go home the same day. When you arrive, you will have an I.V. (a needle in
the vein of the arm) started. You will get medicines that will help you relax, and
drops will be put in your eye. Your eye and the area around it will be numbed so
that you will feel no pain.
Your eye will be cleaned with a yellow liquid, and a cover will be put over your
face to keep the area sterile. The surgeon pushes back the conjunctiva, the thin
outer layer of the eye. A three-sided square cut is made through half of the layers
of the white of the eye. This flap is lifted up, and a hole is made under the flap.
The Ex-Press mini-shunt is inserted into the eye. The flap is gently put back down,
and is held in place with two or more stitches. The conjunctiva is placed back over
the cut. The fluid trickles out of the shunt under the flap and collects under the
conjunctiva to form the bleb. The surgery will take about 1 hour. A patch and
shield or just a shield is placed over the eye for protection. When your IV has been
taken out and you feel well enough, you may return home. This will be about 2
hours after the surgery.
What do I do after I go home?
Leave the patch and shield in place for the first day and night. The eye will be
checked the next day and at several follow up visits. You will be given drugs to
help your eye heal and to prevent inflammation and infection. You should not
take any of the glaucoma drugs you were taking, before the surgery, in the eye
that had surgery. Keep using any medicines you may have been taking in the
Length: 2.64 mm
Width: 400 microns
Glasses or the eye shield should be worn at all times for the first few weeks. The
eye shield should be worn at night to protect the eye. Do not do anything which
makes you strain and hold your breath. Avoid lifting over 10 pounds. Do not bend
over from the waist. If you need to pick up something, bend at the knees. You may
resume sex when you are comfortable; be careful for the first few weeks.
Call the Eye Clinic right away if you have
ξ A sudden loss of vision
ξ Increased pain or discharge in the eye
ξ A large increase in redness or swelling
ξ Nausea or vomiting
University Station Eye Clinic, 8 a.m. to 4:30 p.m., Monday through Friday
When the clinic is closed, your call will be forwarded to the hospital paging
operator. Ask for the “Eye Resident on Call”. Give the operator your name and
phone number with area code. The doctor will call you back.
If you live out of the area, call 1-800-323-8942 and ask to be transferred to the
Please call if you have any questions or concerns.
Your health care team may have given you this information as part of your care. If so, please use it and call if you have
any questions. If this information was not given to you as part of your care, please check with your doctor. This is not
medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each person’s health
needs are different, you should talk with your doctor or others on your health care team when using this information. If
you have an emergency, please call 911. Copyright © 1/2016 University of Wisconsin Hospitals and Clinics Authority.
All rights reserved. Produced by the Department of Nursing. HF#7378