A retrospective study evaluated the use of adjustable sutures in the implantation of the Ex-PRESS filtering device in patients with refractory glaucoma. 75 patients were included in the study, 38 of them in the experimental group with adjustable sutures and 37 in the control group with standard implantation. Both groups achieved a significant reduction in intraocular pressure (IOP) after surgery. Although the experimental group had a higher IOP on the first day after surgery, it subsequently had a significantly lower IOP during the entire 6-month follow-up (P < 0.001). This group also showed a higher proportion of functional filtering blebs (84.21% vs. 62.16%, P = 0.031) and a lower rate of postoperative complications (5.26% vs. 24.32%, P = 0.020). At 6 months, visual acuity did not differ between groups. Some complications in the control group required additional surgical interventions, while no case of endophthalmitis was recorded in any group. The results suggest that the addition of adjustable sutures to the Ex-PRESS implant improves IOP control and reduces complications in the treatment of refractory glaucoma. However, further studies are needed to confirm long-term benefits.