Ex-PRESS miniature glaucoma device implanted under a scleral flap alone or combined with phacoemulsification cataract surgery

Purpose: Our purpose was to evaluate the clinical outcomes of the Ex-PRESS miniature glaucoma device placed under a partial-thickness scleral flap as a single procedure or combined with phacoemulsification cataract surgery. Methods: This was a comparative consecutive case series of 345 eyes: 231 eyes treated with Ex-PRESS implant under scleral flap alone and 114 eyes treated with Ex-PRESS implant under scleral flap combined with phacoemulsification (both groups were treated intraoperatively with mitomycin C). Results: The patients were followed for 25.7±11.1 (range, 1 to 46.2) months (Ex-PRESS alone) and 21.9±12.5 (range, 1.9 to 46.2) months (combined cases). At 3 years after surgery, surgical success was 94.8% and 95.6% in the Ex-PRESS and combined groups, respectively (P=0.948). Compared with baseline values, the postoperative intraocular pressure (IOP) and number of glaucoma medications were significantly lowered in both groups. The change from baseline IOP was significantly greater after Ex-PRESS implant alone compared with combined surgery (P<0.001). The most common device-related complication was obstruction of the tube (6 eyes), which was treated successfully with Nd:YAG laser in all 6 eyes. Conclusions: The use of the Ex-PRESS implant under a scleral flap was effective for lowering IOP both alone and combined with cataract surgery. The most common device-related complication was tube blockage, which was treated with the Nd: YAG laser. © 2009 by Lippincott Williams and Wilkins.