A multi-centre interventional case series of 259 ab-interno Xen gel implants for glaucoma, with and without combined cataract surgery

Karimi, Ayesha; Lindfield, Dan; Turnbull, Andrew M.J.; Dimitriou, Chrysostomos; Bhatia, B.; Radwan, Mahmoud; Gouws, Pieter; Hanifudin, Abdul; Amerasinghe, Nishani; Jacob, Aby

doi:10.1038/s41433-018-0243-8

Cited by 111 publications

(160 citation statements)

References 32 publications

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“…At both time points, patients having received trabeculectomy had a significantly higher IOP reduction compared to patients after XEN gelstent implantation. The changes in IOP after both procedures are similar to reported IOP changes in current literature [20][21][22][23][24]. Gedde et al reported a mean IOP reduction of 12.9 mmHg one year after trabeculectomy, which is slightly higher than the reduction 10.5 mmHg we observed but within the standard deviation range [23].…”

Section: Plos Onesupporting

confidence: 89%

“…Gedde et al reported a mean IOP reduction of 12.9 mmHg one year after trabeculectomy, which is slightly higher than the reduction 10.5 mmHg we observed but within the standard deviation range [23]. Karimi et al found a mean IOP reduction of 5.0 mmHg one year after XEN stent implantation, which is slightly lower than our reduction of 7.2 mmHg, but again within our standard deviation range [24]. It is therefore justified to state that both interventions show beneficiary outcomes.…”

Section: Plos Onesupporting

confidence: 47%

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Efficacy and safety of XEN®—Implantation vs. trabeculectomy: Data of a “real-world” setting

et al. 2020

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ObjectiveTo compare surgical success, postoperative intraocular pressure and complication rates between trabeculectomy and XEN gelstent surgery in a cohort of glaucoma patients in a typical clinical setting. MethodsA retrospective cohort study of consecutive patients with refractory open-angle glaucoma including patients who underwent either stand-alone XEN gelstent insertion with Mitomycin C or trabeculectomy with Mitomycin C between 2016 and 2018 at the University Eye Hospital Mainz, Germany. Primary outcome measure was the proportion of surgical success 1 year after surgery. Patients with an IOP �18mmHg, an intraocular pressure reduction of >20% and in no need of revision surgery or topical medication were considered a complete surgical success. If topical therapy was necessary, they were considered a qualified success. Multivariable logistic regression analysis was carried out for the primary outcome including gender, age, preoperative intraocular pressure and number of medication classes used preoperatively as adjustment variables. Results171 eyes of 144 patients were included, including 82 eyes of 58 patients in the XEN group and 89 eyes of 86 patients in the trabeculectomy group. The primary outcome defined as the proportion of surgical success after 1 year (mean 11.1 months ± 2.2) was similar for both groups. The complete success proportion was 65.5% (95%-CI: 55.6-75.9%) in the trabeculectomy group, and 58.5% (95%-CI: 47.6-69.4%) in the XEN group and not statistically different in our analysis model (crude OR = 0.61; 95%-CI: 0.31-1.22; adjusted OR = 0.66; 95%-CI: 0.32-1.37). The intraocular pressure reduction, as secondary outcome measure, was higher in the trabeculectomy group (10.5 mmHg) compared to the XEN group (7.2 mmHg; p = 0.003) at the 12-month follow-up.Citation: Wagner FM, Schuster AK-G, Emmerich J, Chronopoulos P, Hoffmann EM (2020) Efficacy and safety of XEN®-Implantation vs. trabeculectomy: Data of a "real-world" setting. PLoS ONE 15(4): e0231614. https://doi.org/10.

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Section: Plos Onesupporting

confidence: 89%

Section: Plos Onesupporting

confidence: 47%

Efficacy and safety of XEN®—Implantation vs. trabeculectomy: Data of a “real-world” setting

et al. 2020

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“…Karimi et al retrospectively reviewed 259 eyes across four centers and noted a success rate of 62%; this study included patients with previously failed filtration surgery as well as combined phaco-XEN cases. [18] No difference in IOP reduction or medication use between phaco-XEN and stand-alone XEN surgery was found. However, Mansouri et al, in a prospective study on 149 eyes, noted that patients who underwent standalone XEN procedure had a higher success rate as compared to phaco-XEN cases (40% vs. 22.9%, respectively).…”

Section: Intraocular Pressure Controlmentioning

confidence: 82%

XEN Gel stent: A Review

Dangda¹,

Castanos²,

Do³

et al. 2019

cleverjournal

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Over the last decade, several new surgical devices and treatment options have been developed for the management of glaucoma. Together, known as micro-invasive glaucoma surgery, they aim to provide a safer approach to glaucoma surgery. Although the early devices were used to either stent or ablate a segment of the trabecular meshwork, newer devices such as the XEN gel stent (Allergan Inc., Dublin, Ireland), offer the possibility of creating a safer, more predictable filtering bleb. Since its FDA approval in 2016, several retrospective case series and prospective studies have highlighted the efficacy of the XEN gel stent with regards IOP lowering and reduction in the need for glaucoma medications. The XEN gel stent has also been shown to have a favorable safety profile in terms of intraoperative and post-operative complications. The major concern is the need for bleb intervention in the form of needling and injection of anti-fibrotic agents. This review focuses to summarize the current knowledge on the XEN gel stent for treatment of various subtypes of glaucoma.

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“…While dysaesthetic bleb formation is an unfavourable potential outcome of Xen implants, we have described a stepwise approach for management including details for surgical revision. In our experience, revision surgery has only been needed in very rare circumstances (0.5%) …”

mentioning

confidence: 83%

“…Risk factors for dysaesthetic blebs in trabeculectomy have been shown to include supero‐nasal or nasal location of bleb, which can be the target emergence site for Xen for some surgeons. In our multicentre case series of 215 eyes (currently unpublished), large dysaesthetic blebs occurred in six cases (2.8%) …”

mentioning

confidence: 83%

Hypertrophic dysaesthetic blebs following ab‐interno gel stent (Xen) glaucoma surgery: management and ‘redirect’ revision surgery

Sekaran

Karimi

Lindfield

2018

Clinical Exper Ophthalmology

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A multi-centre interventional case series of 259 ab-interno Xen gel implants for glaucoma, with and without combined cataract surgery

Cited by 111 publications

References 32 publications

Efficacy and safety of XEN®—Implantation vs. trabeculectomy: Data of a “real-world” setting

Efficacy and safety of XEN®—Implantation vs. trabeculectomy: Data of a “real-world” setting

XEN Gel stent: A Review

Hypertrophic dysaesthetic blebs following ab‐interno gel stent (Xen) glaucoma surgery: management and ‘redirect’ revision surgery

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