Early Postoperative Intraocular Pressure is Associated With Better Pressure Control After XEN Implantation

Cutolo, Carlo Alberto; Iester, Michele; Bagnis, Alessandro; Bonzano, Chiara; Negri, Luigi; Olivari, Sara; Cappelli, Francesca; Testa, Valeria; Sindaco, Daniele; Pizzorno, Chiara; Scotto, Riccardo; Saccheggiani, Michela; Traverso, Carlo Enrico

doi:10.1097/ijg.0000000000001501

Cited by 14 publications

(15 citation statements)

References 24 publications

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“…However, considering the systemic and progressive nature of PEXG, it is still unclear why the favourable association of PEXG persists through year 3. The association between the number of needling revisions and surgical failure was previously reported by Midha et al (2019) and supported the results of a large prospective study by Cutolo et al (2020). Indeed, both of these studies reported a similar association and highlighted the fact that the number of needling revisions itself was directly associated with postoperative day 1 IOP.…”

Section: Discussionsupporting

confidence: 88%

Combined and stand‐alone XEN 45 gel stent implantation: 3‐year outcomes and success predictors

Gillmann¹,

Bravetti²,

Rao

et al. 2020

Acta Ophthalmologica

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PurposeTo evaluate the 3‐year treatment outcomes of XEN 45 gel stent in open‐angle glaucoma patients.MethodsIn this prospective, single‐centre interventional study, consecutive eyes with uncontrolled intraocular pressure (IOP) or signs of disease progression despite medical treatment underwent XEN implantation either alone or combined with phacoemulsification (Phaco + XEN).Main outcome measuresSurgical success was defined as 'complete' when 36‐month unmedicated IOP was ≤15 mmHg with a relative IOP reduction ≥ 20% from medicated baseline, while the definition of qualified success allowed no more medications than at baseline. Other definitions of success with different IOP thresholds were also analysed. Secondary outcomes included mean IOP reduction, changes in ocular hypotensive medications and rates of reoperations.ResultsOut of 149 eyes initially included, 92 eyes (61.7%) of 68 patients had complete 3‐year data (XEN: n = 26; Phaco + XEN: n = 66) after 38.2% were lost to follow‐up. Mean age was 76.3 ± 9.1 years, and 66.2% were female. Mean medicated IOP decreased from 20.8 ± 7.4 mmHg (21.0 ± 7.4 [XEN] vs. 20.0 ± 6.9 mmHg [Phaco + XEN]) at baseline to 13.1 ± 3.4 mmHg (12.9 ± 2.9 [XEN] vs. 12.9 ± 3.4 [Phaco + XEN]) at 3 years (−37.0%; p < 0.001). Medications decreased from 1.9 ± 1.3 (2.4 ± 1.5 [XEN] vs. 1.9 ± 1.2 [Phaco + XEN]) to 0.4 ± 0.9 (0.3 ± 0.8 [XEN] vs. 0.5 ± 0.9 [Phaco + XEN]) (−78.9%; p < 0.001). Complete success and qualified success were achieved in 29.0% and 31.0% of eyes, respectively. Needling revision was performed in 51 eyes (55.4%), and 26.1% underwent reoperations. Risk factors for surgical failure included male gender (odds ratio [OR]:3.6; p = 0.03), diagnosis of POAG (OR: 4.5; p < 0.01) and undergoing needling revision (OR: 4.6; p < 0.01). While the type of procedure had no effect on the outcomes of PEXG, POAG eyes undergoing combined surgery had significantly higher rates of failure (OR: 7.29; p = 0.023). Most patients stable at 12‐month remained so through to 3 years.ConclusionsAt 3 years, XEN gel stent implantation achieved clinically significant IOP and medication reduction despite relatively high rates of needling and reoperations. Identifying patients at risk preoperatively may help optimize surgical outcomes.

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Section: Discussionsupporting

confidence: 88%

Combined and stand‐alone XEN 45 gel stent implantation: 3‐year outcomes and success predictors

Gillmann¹,

Bravetti²,

Rao

et al. 2020

Acta Ophthalmologica

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“…The goal of our study was to determine the early predictors of surgical success. In that regard, we found that IOP at postoperative week 1 could be a good predictive value, which was consistent with the findings of Cutolo et al, 17 determining that an IOP of more than 9 mm Hg on postoperative day 1 was a strong predictor of surgical failure after XEN. Similarly, Okimoto et al 11 reported that an IOP of less than 8 mm Hg at postoperative week 2 was linked to a high probability of surgical success after filtering surgery.…”

Section: Discussionsupporting

confidence: 92%

Bleb Analysis Using Anterior Segment Optical Coherence Tomography and Surgical Predictors of XEN Gel Stent

Kim

Lim²,

Rho

2022

Trans. Vis. Sci. Tech.

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Purpose To determine the early predictors of surgical success 6 months after XEN surgery among clinical parameters, including anterior segment optical coherence tomography (AS-OCT). Methods A total of 31 eyes with medically uncontrolled primary open-angle glaucoma or pseudoexfoliation glaucoma was enrolled retrospectively. Using AS-OCT, XEN tip location was categorized into intraconjunctival, intratenon, or uviform at day 1 and blebs were classified into no or low, high sparse, high thick, cystic, or mixed walls at month 6. Using slit-lamp photography, blebs were classified into no or low, localized avascular, diffuse avascular, localized vascular, or diffuse vascular blebs at month 6. Surgical success was defined as an intraocular pressure (IOP) of less than 14 mm Hg. Results Intraconjunctival and intratenon locations of the tip mostly created a high sparse wall, whereas the uviform type mostly created no or low wall and no or low bleb. The uviform type was linked to pseudoexfoliation glaucoma. A high sparse wall and diffuse avascular bleb showed a lower mean IOP than a high thick wall and localized vascular bleb. In the multivariate analysis, female sex and IOP at week 1 were early predictors of surgical success (8.45 times and 33.1% per 1 mm Hg-decrease, respectively). Conclusions Bleb evaluation using AS-OCT is valuable to correlate tip location and bleb morphology with clinical profiles, considering that a lower early postoperative IOP is linked to surgical success. Translational Relevance Bleb analysis using AS-OCT on day 1 could help to predict bleb morphology after 6 months, which is important to maintain the functioning bleb in the longer term.

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“…Early postoperative IOP values have also been evaluated as potential predictors for failure and success. Previous publications have reported that an elevated first 24 h IOP measurement could be significantly associated with failure 15 and greater needling rates. 16 However, other factors like stent positioning, transient reduced aqueous humor production, and remaining ocular viscoelastic also determine this first day IOP assessment and therefore need to be taken into account.…”

Section: Discussionmentioning

confidence: 94%

“…16 However, other factors like stent positioning, transient reduced aqueous humor production, and remaining ocular viscoelastic also determine this first day IOP assessment and therefore need to be taken into account. 15 Moreover, modifications in the bleb morphology have been described up to the first postoperative month which could result in better IOP outcomes at a later stage. 17 In this regard, Fea et al 18 have suggested using 1 month postoperative IOP determinations as a predictor of success, finding that a difference of <6 mmHg between week-1 and month-1 intraocular pressure measurements was associated with a final IOP of <16 mmHg.…”

Section: Discussionmentioning

confidence: 99%

XEN45 real-life evaluation: Survival analysis with bleb needling and major revision outcomes

Ventura-Abreu

Dotti-Boada

Muniesa-Royo

et al. 2021

European Journal of Ophthalmology

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Purpose: To evaluate real-life outcomes of XEN45 stent surgery including bleb needling (BN) and surgical bleb revision (SBR). Methods: Retrospective analysis of all XEN45 gel stents implanted in a tertiary glaucoma center with a minimum follow-up of 6 months. The main outcomes were intraocular pressure (IOP), the number of glaucoma medications, postoperative maneuvers like BN, and subsequent SBR. Success was defined as IOP ⩽ 18 and 20% reduction (criterion A), ⩽15 and 25% reduction (criterion B), and ⩽12 mmHg and 30% reduction (criterion C) reached with (qualified) or without (complete) medications at the last visit. Complete failure was defined as additional glaucoma surgery, loss of light perception, or sight-threatening complications. Multivariable Cox regression and Kaplan-Meier survival estimates tests were performed. Results: Fifty-eight eyes with either stand-alone or combined Phaco-XEN surgery were included. Complete success by the different definitions was 50.0% (95% confidence interval, 5.8%–84.5%) (A), 50.0% (5.8%–84.5%) (B), and 25% (0.9%–66.5%) (C) whereas qualified success was 38.3% (1.6%–80.1%), 31.7% (2.0%–71.4%), and 0%, respectively, at the 24-months visit. 30% of cases underwent BN with 5-Fluorouracil, and SBR was performed in 17.5% of eyes. Low IOP levels at 1-month and early BN were significantly associated with success. The highest chance of failure was achieved in the combined Phaco-XEN group undergoing SBR. Conclusions: In our real-life setting, the first month IOP was associated with greater success rates. Although BN obtained improved IOP values, SBR was associated with a greater bleb survival in the stand-alone XEN group. Both BN and SBR had poor outcomes in the combined Phaco-XEN group.

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Early Postoperative Intraocular Pressure is Associated With Better Pressure Control After XEN Implantation

Cited by 14 publications

References 24 publications

Combined and stand‐alone XEN 45 gel stent implantation: 3‐year outcomes and success predictors

Combined and stand‐alone XEN 45 gel stent implantation: 3‐year outcomes and success predictors

Bleb Analysis Using Anterior Segment Optical Coherence Tomography and Surgical Predictors of XEN Gel Stent

XEN45 real-life evaluation: Survival analysis with bleb needling and major revision outcomes

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