I fail to understand the advantage of the ExPRESS shunt. One still has to perform all the steps of a traditional trabeculectomy (except for excising a piece of the trabecular tissue, which is the easiest part of the surgery anyway), including a scleral flap, conjunctival dissection and the creation of a bleb. And since the vast majority of failures in trabs are related to scar tissue in the conjunctiva, I don’t see how the shunt would increase the success rate, as it would have no effect on that. We need a procedure which doesn’t require a bleb and has a low complication rate.