title: Combined Ex-PRESS LR-50/IOL implantation in modified deep sclerectomy plus phacoemulsification for glaucoma associated with cataract.
abstract: OBJECTIVE
  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.
authors.affiliation: Jules Gonin Eyes Hospital, Department of Ophthalmology, Lausanne University, Lausanne, Switzerland.
authors.forename: Fanny
authors.initials: F
authors.lastname: Gindroz
authors.forename: Sylvain
authors.initials: S
authors.lastname: Roy
authors.forename: André
authors.initials: A
authors.lastname: Mermoud
authors.forename: Corinne C
authors.initials: CC
authors.lastname: Schnyder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000150:complications* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D007431:Intraoperative Complications; D019654:Lens Implantation, Intraocular; D008297:Male; D018918:Phacoemulsification; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012590:Sclera / Q000601:surgery; D012599:Sclerostomy; D014065:Tonometry, Ocular; D014792:Visual Acuity / Q000502:physiology