Cataract and glaucoma combined surgery: XEN® gel stent versus nonpenetrating deep sclerectomy, a pilot study

Theillac, Vincent; Blumen-Ohana, E.; Hamard, P.; Sellam, Alexandre; Brasnu, Emmanuelle; Baudouin, Christophe; Labbé, Antoine; Nordmann, Jean‐Philippe

doi:10.1186/s12886-020-01492-z

Cited by 9 publications

(27 citation statements)

References 32 publications

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“…To date, cost-effectiveness evidence for the XEN gel stent is not available (89), which will be the main consideration that will definitely affect the acceptance of new surgical procedures. Theillac et al (48) suggested that compared with the traditional filtration surgery, XEN implantation could reduce operation time, which could be used to perform other surgical procedures, and offset the additional cost. Marques et al (90) and Busch et al (60) intended to evaluate the learning curve of XEN gel stents with several surgeons from different professional fields.…”

Section: Discussionmentioning

confidence: 99%

“…In another study comparing XEN implantation and EX-PRESS drainage device implantation (15), EX-PRESS showed superiority in terms of success rate although XEN implantation could reduce the risk of hypotony and choroidal effusion with fewer postoperative clinical visits. In another 9-month followup study, non-penetrating deep sclerectomy (NPDS) with MMC was compared with XEN gel stent implantation with MMC (48). The mean reduction in IOP between baseline and the last follow-up was −18.9 ± 5.2% and −25.6 ± 4.3% in the XEN and NPDS groups, respectively (p = 0.39).…”

Section: Comparison With Other Surgeriesmentioning

confidence: 99%

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The Outcomes of XEN Gel Stent Implantation: A Systematic Review and Meta-Analysis

et al. 2022

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PurposeXEN gel stents are used for the treatment of open-angle glaucoma (OAG), including primary and secondary glaucoma that are uncontrolled by previous medical therapy and cases with previous failed surgery. Our aim was to systematically review of the clinical data of currently published ab-interno XEN gel stents with an emphasis on intraocular pressure (IOP), antiglaucoma medication outcomes, and safety profiles.MethodsWe analyzed all of the publications (MEDLINE, EMBASE, Cochrane Library) on the ab-interno XEN gel stent to evaluate the reduction in IOP and antiglaucoma medications following the procedure. The primary outcomes measured for the meta-analysis were reduction in IOP and anti-glaucoma medications. The secondary outcome were adverse events. For each study, we used a random effects analysis model to calculate the mean difference and 95% confidence intervals for the continuous results (reduction in IOP and antiglaucoma medications) using the inverse variance statistical method.ResultsFive hundred twenty-seven articles were checked and 56 studies were found to be relevant with a total of 4,410 eyes. There was a significant reduction in IOP as well as in the number of medications required in patients treated with ab-interno XEN implant either alone or combined with cataract surgery. This new treatment for various types of glaucoma reduced the IOP by 35% to a final average close to 15 mmHg. This reduction was accompanied by a decrease in the number of antiglaucoma medications in all the studies, approximately 2 classes of medication at the price of more needlings. The overall complete success rate was 21.0–70.8% after 2 years using strict criteria originally designed to record success rate in filtration surgery. The incidence of complications vision-threatening was low at <1%.ConclusionsXEN gel stent was effective and safe for primary and secondary OAG. Further studies should be performed to investigate the impact of ethnicity on the success and failure rate after XEN implantation.

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Section: Discussionmentioning

confidence: 99%

Section: Comparison With Other Surgeriesmentioning

confidence: 99%

The Outcomes of XEN Gel Stent Implantation: A Systematic Review and Meta-Analysis

et al. 2022

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“…A recent nonrandomized retrospective monocentric study compared both procedures combined with cataract surgery without demonstrating any difference in the risk of success or safety profile. 18 However, the short followup may not have revealed a real difference. A total of 328 eyes of 282 consecutive glaucomatous patients over 18 and scheduled for standalone XEN implantations (n = 140) or NPDS (n = 188) in our institution were assessed for eligibility.…”

mentioning

confidence: 99%

One-Year Outcomes of Standalone XEN Gel Stent Versus Nonpenetrating Deep Sclerectomy

Touboul¹,

Fels

Morin³

et al. 2022

Journal of Glaucoma

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Précis: The nonpenetrating deep sclerectomy (NPDS) procedure resulted in significantly more surgical success than the standalone XEN gel stent procedure without differences in safety profile. Purpose:The purpose of this study was to compare surgical success and safety profile of NPDS and XEN gel stent.Methods: A retrospective chart review of 328 eyes of 282 patients who were scheduled for standalone XEN gel stent surgery (n = 140) or NPDS (n = 188) at Groupe Hospitalier Paris Saint-Joseph between January 2017 and December 2018 was conducted. Primary outcome measure was the proportion of surgical success 12 months after surgery. Complete and qualified surgical successes were defined by intraocular pressure (IOP) ≤ 18 mm Hg and a reduction of IOP ≥ 20% without or with hypotensive medication, respectively.Results: In total, 82 eyes were included in the XEN group and 124 eyes in the NPDS group. In the 1-eye analysis, rates of "complete success" and "qualified success" were, respectively, at the end of follow-up, 28.57% and 20.00% in the XEN group, and 42.72% and 16.50% in the NPDS group (P = 0.17). Success probability plots based on the Kaplan-Meier estimate for overall surgical success demonstrated a median success probability time of 3.73 years for the NPDS group and 2.38 years for the XEN group (P < 0.0001). After adjustment for confounding variables using Cox regression, the NPDS procedure was significantly more associated with surgical success than the XEN gel stent implantation (P < 0.001). No difference was demonstrated in terms of reduction of antiglaucoma medications, needling procedures, or reoperations. Conclusions:The NPDS procedure may be more effective than the XEN gel stent in reducing IOP in patients with open angle glaucoma and may result in longer surgical success. However, a well-conducted prospective randomized study is required to confirm these results.

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“…The weighted mean Forty-five studies (n = 3122 total eyes) reported 12-month outcomes with complete pre-and postoperative IOP and medication use. 4,5,[10][11][12]15,19,20,25,[27][28][29][30][31][32][33][35][36][37][38][39][40][42][43][44][45][46][47][48][51][52][53]55,[57][58][59][60][62][63][64][65][66][67][68] In these studies, the median number of eyes followed was 52 (range, 12-242) and median age was 72.2 years (range, 53.4-80.9). The weighted mean preoperative IOP was 22.2 mm Hg on 2.5 glaucoma medications, and the weighted mean postoperative IOP was 14.2 mm Hg on 0.7 glaucoma medications.…”

Section: Efficacy Outcomesmentioning

confidence: 97%

Intraocular Pressure and Medication Changes Associated with Xen Gel Stent: A Systematic Review of the Literature

Panarelli¹,

Vera²,

Sheybani³

et al. 2023

OPTH

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The Xen gel stent (Allergan Inc, an AbbVie company; Dublin, Ireland) was conceived as an option for patients requiring modest IOP reduction but for whom trabeculectomy was not yet indicated. As with any glaucoma surgery, establishing criteria for patient selection and identifying factors that contribute to a high likelihood of success are important. To help guide clinical decisionmaking, a systematic review of published studies on the gel stent was performed, with the goal of understanding postoperative outcomes based on clinical and patient factors. Results were organized around a series of pertinent clinical questions based on scenarios encountered in clinical practice. Criteria for including studies were intentionally broad, with the objective of simulating the diverse population of glaucoma patients encountered in real-world practice. Outcomes for IOP and medication reduction postoperatively were assessed in various analyses, including in eyes with various glaucoma types and severity; in eyes naïve to surgery as well as those with a history of prior incisional glaucoma surgery; and when surgery was performed as a standalone procedure or at the time of cataract surgery. The results of each of the various analyses were consistent in demonstrating that successful gel stent surgery achieved a postoperative IOP of approximately 14.0 mm Hg and reduction to fewer than 1 glaucoma medication. Additional data are shown on outcomes by method of implant (ab interno vs ab externo); intraoperative use of antifibrotics; and rates of needling in published studies.

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Cataract and glaucoma combined surgery: XEN® gel stent versus nonpenetrating deep sclerectomy, a pilot study

Cited by 9 publications

References 32 publications

The Outcomes of XEN Gel Stent Implantation: A Systematic Review and Meta-Analysis

The Outcomes of XEN Gel Stent Implantation: A Systematic Review and Meta-Analysis

One-Year Outcomes of Standalone XEN Gel Stent Versus Nonpenetrating Deep Sclerectomy

Intraocular Pressure and Medication Changes Associated with Xen Gel Stent: A Systematic Review of the Literature

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