Factors influencing the reduction in corneal endothelial cells after Ex-Press® surgery

  • Naoki TojoEmail author
  • Ayaka Numata
  • Atsushi Hayashi
Original Paper



We investigated the factors that influence the reduction in corneal endothelial cells after Ex-Press® surgery.


This was a retrospective study. We included patients who had undergone Ex-Press surgery and were followed up for > 2. We analyzed the corneal endothelial cell density (ECD) before and after Ex-Press surgery. We investigated the insertion position (Ex-Press device was inserted into cornea or trabecular meshwork (TM)), Ex-Press–iris touch, cornea–iris touch, peripheral anterior synechiae, history of trabeculotomy, history of selective laser trabeculoplasty, type of glaucoma, and simultaneous cataract surgery as influencing factors. We used multivariate analysis to determine the factors influencing the reduction rate of ECD.


We included 129 eyes. The mean of ECD had decreased 7.0% at 2 years. Ex-Press surgeries significantly decreased the ECD after 2 years (p = 0.0118). As a result of the multivariate analysis, the factor that led to a significantly faster reduction in ECD was the insertion position of the Ex-Press (p < 0.0001). The reduction rate of ECD after 2 years in cases of insertion into the cornea (27 eyes) was 15.1 ± 3.6%, and in cases of insertion into a TM (102 eyes), it was 5.2 ± 1.4%.


Insertion into the cornea was a risk factor for rapid ECD loss. The Ex-Press should be inserted into a TM for long-term protection of the corneal endothelial cells.


Ex-Press Glaucoma Corneal endothelial cells Factors 



No funding was received.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.

Human and animals rights

All procedures performed were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards, and ethical approval was obtained from the Institutional Review Board of the University of Toyama.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Nature B.V. 2020

Authors and Affiliations

  1. 1.Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical SciencesUniversity of ToyamaToyamaJapan

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