To report a case of fibrotic obstruction of scleral orifice in Ex-PRESS shunt.

A 57-year-old male presented with elevated intraocular pressure in his left eye. In the past, laser photocoagulation was performed at a local clinic due to retinal venous occlusion in his left eye. During observation, he was transferred to our hospital due to uncontrolled intraocular pressure despite antiglaucoma medications. He was diagnosed with neovascular glaucoma in the left eye. Since intravitreal injection of anti-vascular endothelial growth factor with maximal medical therapy did not lower the intraocular pressure, an Ex-PRESS shunt device was implanted. Two weeks postoperatively, the bleb was flat and diffuse with shallow anterior chamber and intraocular pressure was below 5 mm Hg. Therefore, we performed scleral flap revision and intraocular pressure was sustained between 10 and 15 mm Hg. Two months postoperatively, the patient experienced high intraocular pressure and no elevated bleb, thus we performed bleb revision. During the surgery, although we removed fibrotic adhesions between the conjunctiva and episclera using a 30-gauge needle, aqueous outflow was not observed. Therefore, we opened the scleral flap and found the scleral orifice of the Ex-PRESS shunt was obstructed by fibrous scar tissue. After scar tissue removal and achieving aqueous outflow through the scleral opening, intraocular pressure decreased to a satisfactory level.

In patients with elevated intraocular pressure after implantation of the Ex-PRESS shunt, the scleral opening of the Ex-PRESS shunt should be examined for obstruction.