Improved Ex-PRESS Glaucoma Miniature Drainage Device Implantation Combined With Cataract Extraction And Intraocular Lens Implantation

Objective.To evaluate the efficacy and safety of improved Ex-PRESS glaucoma miniature drainage device implantation combined with cataract extraction and intraocular lens implantation in the treatment of primary glaucoma with cataract.Methods.Retrospective clinical case study.A total of 67 patients(88 eyes)who were diagnosed as primary glaucoma with cataract and were treated with Ex-PRESS glaucoma miniature drainage device implantation combined with cataract extraction and intraocular lens implantation were divided into conventional group and improved group according to two sizes of surgical incision.6mm based on fornix conjunctival flap and isosceles triangular lamellar scleral flap with the size of 3.5mm×3.5mm were made in the conventional group,while "L" conjunctival flap with the size of 3.5mm×1.5mm and isosceles triangular lamellar scleral flap with the size of 2.5mm×2.5mm were made in the improved group.The intraocular pressure(IOP),best corrected visual acuity(BCVA),the number of post-operative anti-glaucoma medications,the success rate of operation,filtering bleb,reoperation rate,and the incidence of post-operative complications were compared between the two groups at 1 day,1 week,1month and3 month after operation.Results.The difference of eyes,sex,average age,pre-operative average IOP,pre-operative average BCVA,the number of various types of glaucoma and the history of anti-glaucoma surgery were comparable between the two groups and the difference was not statistically significant(P>0.05).Post-operative IOP,BCVA and the number of post-operative anti-glaucoma medications within the two groups were statistically significant(P<0.05)comparing with before operation.IOP at 3month was significantly different(P < 0.05)between the two groups,and the effect of lowering intraocular pressure in the improved group is better than that in the conventional group.There was significant difference in BCVA between the two groups except at 3month and BCVA during post-operative 1day-1month in the improved group was significantly higher than that in the conventional group.There was not statistically significant(P > 0.05)in post-operative IOP among and within groups of different types of primary glaucoma.There were no serious complications in the two groups,and there was no significant difference(P>0.05)in the number of post-operative anti-glaucoma medications and the incidence of complications between the two groups(P > 0.05).The success rate of operation in each follow-up period of the conventional group was more than 80%,and that of the improved group was more than 90%.The proportion of functional filtering blebs in the improved group was higher than that in the conventional group.Conclusion.Ex-PRESS glaucoma miniature drainage device implantation with two sizes of surgical incision combined with cataract extraction and intraocular lens implantation was effective and safe in the treatment of primary glaucoma with cataract.Compared with the conventional group,the improved group has the advantages of simpler operation,less ocular tissue trauma and better effect of lowering IOP in the medium and short term(post-operative 3month).