Combined Ex-PRESS LR-50/IOL Implantation in Modified Deep Sclerectomy plus Phacoemulsification for Glaucoma Associated with Cataract

PURPOSE: This is a prospective study reporting on modified deep sclerectomy (DS) using the Ex-PRESS LR-50 in combined cataract and glaucoma surgery. METHODS: Twenty-four eyes of 24 patients with medically uncontrolled glaucoma underwent modified DS. After phacoemulsification and intraocular lens implantation, the Ex-PRESS LR-50 was inserted into the anterior chamber under a scleral flap. A partial posterior DS was performed to provide an intrascleral bleb. The complete success rate was intraocular pressure (IOP) without medication =18 mmHg; the qualified success rate was IOP =18 mmHg with or without medication. Postoperative bleb management (subconjunctival mitomycin C injections ± needling) was performed in case of postoperative hypertension or bleb fibrosis. RESULTS: Follow-up was 40.1±10.8 (mean ± SD) months. Preoperatively, IOP was 18.1±5.3 mmHg, best-corrected visual acuity (BCVA) was 0.6±0.3, and number of medications was 2.3±1.1. The IOP decreased by 25.4% at 24 months and by 27.0% at 48 months. At 24 months, 19 patients (86.3%) achieved a BCVA of 0.5 or better, and at 48 months the mean BCVA was 0.7±0.3. At the last visit, the mean number of medications was 0.6±0.8 (p<0.05). The complete and qualified success rates were 45.6% and 85.2%. Mitomycin C injections were performed in 5 eyes. No conjunctival erosions over the Ex-PRESS LR-50 were seen. CONCLUSIONS: The Ex-PRESS LR-50 inserted into the anterior chamber after modified DS efficiently lowers IOP in combined surgery, preventing conjunctival erosion, a significant complication when using this device without scleral flap coverage.