Efficacy of ab-interno gelatin microstent implantation in primary and refractory glaucoma

Szigiato, Andrei-Alexandru; Touma, Samir; Jabbour, Samir; Lord, Frederic M.; Agoumi, Younes; Singh, Harmanjit

doi:10.1016/j.jcjo.2022.02.012

Cited by 3 publications

(3 citation statements)

References 35 publications

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“…Six papers have evaluated the longer-term efficacy of XEN45 in terms of IOP lowering and reducing the number of ocular hypotensive medications, (See Table 4 ). With the exception of one paper (n = 23 eyes), which reported an IOP of 19.6 ± 2.1 mmHg at 36 months [ 78 ], currently available evidence shows good hypotensive effects for XEN45, with IOPs at 36–48 months in the range of 13–14 mmHg, as well as a significant reduction in the number of ocular hypotensive medications [ 45 , 61 , 81 , 87 , 88 , 94 , 101 ]. In addition, compared to preoperative values, the reduction in IOP was greater than 30% ( Table 4 ).…”

Section: Resultsmentioning

confidence: 99%

“…Regarding its implantation technique, XEN has usually been delivered using an ab interno approach through a corneal incision [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , ...…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness and Safety of Xen Gel Stent in Glaucoma Surgery: A Systematic Review of the Literature

Traverso

Carassa²,

Fea

et al. 2023

JCM

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Although topical medical therapy and selective-laser-trabeculoplasty represent the treatments of choice to reduce intraocular pressure, many patients do not achieve adequate glaucoma control; therefore, they require further options and eventually surgery. Trabeculectomy is still considered the gold standard, but the surgical management of glaucoma has undergone continuous advances in recent years, XEN-gel-stent has been introduced as a safer and less traumatic means of lowering intraocular pressure (IOP) in patients with open-angle glaucoma (OAG). This study aimed to review the effectiveness and safety of clinical data on XEN-stent in OAG patients with a Synthesis-Without-Meta-analysis (SWiM) methodology. A total of 339 studies were identified following a literature search adhering to PRISMA guidelines and, after evaluation, 96 studies are discussed. XEN63 and XEN45 device data were collected both short and long term. In addition, this document has evaluated different aspects related to the XEN implant, including: its role compared to trabeculectomy; the impact of mitomycin-C dose on clinical outcomes; postoperative management of the device; and the identification of potential factors that might predict its clinical outcomes. Finally, current challenges and future perspectives of XEN stent, such as its use in fragile or high myopia patients, were discussed.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of Xen Gel Stent in Glaucoma Surgery: A Systematic Review of the Literature

Traverso

Carassa²,

Fea

et al. 2023

JCM

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“…ME is a transient and generally benign condition associated with the combined therapy of XEN gel stent implantation and phacoemulsification. It has been reported to have an incidence of 1.5–4.3% ( 62 , 74 , 75 ). In a study that followed 261 eyes receiving XEN gel stent implantation with or without phacoemulsification for an average of 8.5 months, four cases of ME occurred.…”

Section: Systematic Reviewmentioning

confidence: 99%

Complications of XEN gel stent implantation for the treatment of glaucoma: a systematic review

Gan,

Wang,

Chen

et al. 2024

Front. Med.

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AimThis study was aimed to summarize the complications and their management associated with XEN gel stent implantation.MethodsA systematic review of literature was conducted using Medline (via PubMed), EMBASE, the Cochrane Library databases, and China National Knowledge Infrastructure, from their inception to February 1, 2024.ResultsA total of 48 studies published between 2017 and 2024 were identified and included in the systematic review, including 16 original studies (retrospective or prospective clinical studies), 28 case reports, and 4 case series, which followed patients for up to 5 years. Early postoperative complications of XEN gel stent implantation include hypotony maculopathy (1.9–4.6%), occlusion (3.9–8.8%), suprachoroidal hemorrhage (SCH), choroidal detachment (0–15%), conjunctival erosion, and exposure of the XEN gel stent (1.1–2.3%), wound and bleb leaks (2.1%) and malignant glaucoma (MG) (2.2%). Mid-postoperative complications of XEN gel stent implantation included migration of XEN (1.5%), ptosis (1.2%), endophthalmitis (0.4–3%), macular edema (1.5–4.3%), hypertrophic bleb (8.8%) and subconjunctival XEN gel stent fragmentation (reported in 2 cases). Late postoperative complications reported in cases included spontaneous dislocation and intraocular degradation.ConclusionXEN gel stent implantation is a minimally invasive glaucoma surgery (MIGS) procedure for glaucoma, known for its potential to minimize tissue damage and reduce surgical duration. However, it is crucial to note that despite these advantages, there remains a risk of severe complications, including endophthalmitis, SCH, and MG. Therefore, postoperative follow-up and early recognition of severe complications are essential for surgical management.

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Two-year outcomes of Xen 45 gel stent implantation in patients with open-angle glaucoma: real-world data from the Fight Glaucoma Blindness registry

Arnould,

Balsat,

Hashimoto

et al. 2024

Br J Ophthalmol

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ObjectiveTo evaluate efficacy and safety outcomes of the Xen 45 gel stent implant over 24 months of follow-up.MethodsA retrospective analysis of prospectively collected data from the Fight Glaucoma Blindness observational registry. Complete success (CS) was defined as intraocular pressure (IOP) reduction ≥20% from preoperative and an IOP ≤18 mm Hg and ≥6 mm Hg with no secondary procedure at 2 years and without IOP-lowering medications. Qualified success (QS) was defined similarly, allowing the use of IOP-lowering medications.ResultsThe Xen 45 gel stent implant was implanted in 646 eyes of 515 patients. Preoperative IOP was 21.4±7.6 (mean±SD) mm Hg on 2.7±1.3 IOP-lowering medication and mean deviation was −10.2±8.4 dB. After 24-month follow-up, IOP was 16.8±7.3 mm Hg (mean reduction of 21.7%) on 1.2±1.4 IOP-lowering medications. CS and QS rates at 24 months were 26% and 48%, respectively. CS and QS were higher in the Xen stand-alone group (33% and 52%, respectively) than in the Xen+cataract group (16% and 42%, respectively). Bleb needling was performed in 28.4% of cases, and 18% underwent a secondary procedure.ConclusionsThe Xen 45 gel stent implant offers acceptable long-term efficacy for the treatment of open-angle glaucoma. However, there is a significant rate of reoperation and needling, and outcomes are less effective if combined with cataract surgery.

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Efficacy of ab-interno gelatin microstent implantation in primary and refractory glaucoma

Cited by 3 publications

References 35 publications

Effectiveness and Safety of Xen Gel Stent in Glaucoma Surgery: A Systematic Review of the Literature

Effectiveness and Safety of Xen Gel Stent in Glaucoma Surgery: A Systematic Review of the Literature

Complications of XEN gel stent implantation for the treatment of glaucoma: a systematic review

Two-year outcomes of Xen 45 gel stent implantation in patients with open-angle glaucoma: real-world data from the Fight Glaucoma Blindness registry

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