The EX‐PRESS glaucoma shunt versus nonpenetrating deep sclerectomy with Esnoper implant in combined surgery for open‐angle glaucoma: a prospective randomized study

Purpose To report 1‐year treatment outcomes of P50 EX‐PRESS implant versus nonpenetrating deep sclerectomy (NPDS) with Esnoper V2000 combined with phacoemulsification. Design Randomized, prospective and multicentre clinical trial. Methods Settings: Six clinical centres. Population: Patients 54–89 years of age without previous filtering surgery with cataract and glaucoma who required lower levels of intraocular pressure (IOP). Interventions: Phaco‐EX‐PRESS P50 or Phaco‐NPDS with Esnoper V2000, both groups with mitomycin C (0.2 mg/ml for 2 min). Main outcome measures: IOP, complete success rate (IOP: ≥6 and ≤18 mmHg), visual acuity, use of medical therapy and systematic assessment of complications and postoperative interventions. Results A total of 98 eyes were enrolled, including 50 in the EX‐PRESS group and 48 in the NPDS group. At 12 months, IOP (mean ± SD) was 13.9 ± 3.3 mmHg in EX‐PRESS group and 13.3 ± 3.6 mmHg in NPDS group (p = 0.38). Success rate was 75% and 80% in EX‐PRESS and NPDS groups, respectively (p = 0.53). The number of glaucoma medications (mean ± SD) was 0.2 ± 0.55 in EX‐PRESS group and 0.17 ± 0.44 in NPDS group (p = 1.00). The total number of complications was 66 in 35 subjects in EX‐PRESS group and 39 in 23 subjects in NPDS group (p = 0.02). The incidence of more than one complication was n = 13 (26%) versus n = 9 (18.8%) in EX‐PRESS and NPDS groups, respectively (p = 0.38). The total number of required postoperative interventions was 59 and 26 in EX‐PRESS and NPDS groups, respectively (p = 0.01). Visual acuity was similar in both groups at month 12 (p = 0.13). Surgical time (mean ± SD) was 52.6 ± 13.6 min in EX‐PRESS group and 63.3 ± 19.4 min in NPDS group (p = 0.01). Conclusion Phaco‐EX‐PRESS surgery had similar success rate compared to Phaco‐NPDS during 1 year of follow‐up. Both procedures were associated with similar IOP reduction and use of additional medical therapy at 12 months. EX‐PRESS surgery required more postoperative interventions and had more complications, but needed less surgical time compared to NPDS.