We would like to thank Ates and associates for their precious contribution and for the interest they have shown in our article. In their remarkable research, they evaluated the implant of EX-PRESS mini shunt in 15 glaucomatous patients who had previously undergone penetrating keratoplasty. During 12.2 months mean follow-up, none of the patients in the study experienced worsening of the graft.

Postkeratoplasty glaucoma (PKG) is a non-negligible issue that can affect up to 34% of patients, as reported in previous studies. In cases refractory to medical therapy, choosing the appropriate surgical treatment, as well as determining an early diagnosis and administering prompt treatment, may contribute to the avoidance of untimely graft failure.

As reported in our paper, the EX-PRESS glaucoma mini shunt has some advantages if compared to the Ahmed glaucoma valve implant. It is made of steel instead of silicone and has a smaller size, and this may result in greater stability and less chance of contact with the endothelium. Furthermore, postoperative inflammation is reduced thanks to the low invasiveness of the implant and the short operative time required. In conclusion, in PKG cases the EX-PRESS mini shunt implant may be a valid option to preserve the survival of the graft.