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The patients underwent combined phacoemulsification and Ex-PRESS implant (Phaco-ExPRESS, n\u2009=\u200935) or phacotrabeculectomy (Phaco-Trab, n\u2009=\u200935). The morphological structures of the filtering bleb were examined by slit-lamp, anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM). Complete success was defined as postoperative intraocular pressure (IOP)\u2009&lt;\u200918\u00a0mmHg without the use of anti-glaucoma medication. Qualified success was defined as postoperative IOP\u2009&lt;\u200918\u00a0mmHg with or without anti-glaucoma medications. The data were collected preoperatively and postoperatively at 2\u00a0weeks, 1\u00a0month, 3\u00a0months, 6\u00a0months, and 12\u00a0months.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>No significant difference in the variables such as age, IOP and perimetry was found between the groups of Phaco-ExPRESS and Phaco-Trab. At the one-year postoperative visit for filtering blebs, Phaco-ExPRESS increased the mean area of epithelial microcysts significantly from 0.10\u2009\u00b1\u20090.05 to 0.20\u2009\u00b1\u20090.09 \u03bcm<jats:sup>2<\/jats:sup> per \u03bcm<jats:sup>2<\/jats:sup>, while Phaco-Trab decreased the mean area significantly from 0.08\u2009\u00b1\u20090.04 to 0.04\u2009\u00b1\u20090.06 \u03bcm<jats:sup>2<\/jats:sup> per \u03bcm<jats:sup>2<\/jats:sup>. Notably, the hyperreflective dots detected by IVCM decreased by 84.9% in Phaco-ExPRESS but increased by 36.3% in Phaco-Trab. The hyperreflective dots were further identified as neutrophil- and monocyte-like cells. The number of these cells were negatively correlated with the microcysts area (r\u2009=\u2009\u2009\u2212\u20090.7, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01) but positively associated with the grade of connective tissue (r\u2009=\u20090.5, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01). By creating different microstructural changes in the filtering blebs, Phaco-ExPRESS produced a higher complete success rate (84.9% <jats:italic>vs.<\/jats:italic> 41.2%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01) and significant decrease in the number of anti-glaucoma medications (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01) when compared with those in Phaco-Trab. However, the qualified success showed no significant difference between the two groups (100.0% vs. 91.2%, <jats:italic>P<\/jats:italic>\u2009=\u20090.24).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>At the one-year follow-up, Phaco-ExPRESS generated better filtering bleb with larger area of microcysts, looser connective tissues, and less inflammation than that of Phaco-Trab, providing adequate IOP control and less IOP-lowering medications. These findings indicate that Phaco-ExPRESS could be more preferred than Phaco-Trab for the treatment of patients with coincident POAG and cataract.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s40662-022-00278-2","type":"journal-article","created":{"date-parts":[[2022,2,12]],"date-time":"2022-02-12T13:02:41Z","timestamp":1644670961000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Comparison of Ex-PRESS implantation versus trabeculectomy combined with phacoemulsification in primary open-angle glaucoma: a retrospective in vivo confocal microscopy study"],"prefix":"10.1186","volume":"9","author":[{"given":"Yuqiao","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beiting","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yulin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanlei","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongyi","family":"Niu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Honghua","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongjie","family":"Qin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1289-8327","authenticated-orcid":false,"given":"Hongyang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,2,10]]},"reference":[{"issue":"11","key":"278_CR1","doi-asserted-by":"publisher","first-page":"1854","DOI":"10.1016\/S0886-3350(01)01127-0","volume":"27","author":"RJ Casson","year":"2001","unstructured":"Casson RJ, Salmon JF. 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It was approved by the Guangdong Provincial People\u2019s Hospital (No. GDREC2019406H). Informed consent was obtained from all patients.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"7"}}