Efficacy of the XEN-Implant in Glaucoma and a Meta-Analysis of the Literature

Poelman, Huub J; Pals, Jan; Rostamzad, Parinaz; Bramer, Wichor M.; Wolfs, Roger C. W.; Ramdas, Wishal D.

doi:10.3390/jcm10051118

Cited by 18 publications

(31 citation statements)

References 32 publications

(19 reference statements)

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“…Poelman et al 30 found not significant differences between Xen standalone or in combination with phacoemulsification in both IOP-lowering (32.6% and 20.9%, respectively, p = 0.054) and reduction of ocular hypotensive medications (66.9% and 63.8%, respectively, p = 0.638).…”

Section: Discussionmentioning

confidence: 96%

Clinical outcomes of combined Preserflo Microshunt implantation and cataract surgery in open-angle glaucoma patients

Martínez-de-la-Casa

Sáenz-Francés

Morales-Fernández

et al. 2021

Sci Rep

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To assess the effectiveness and safety of the Preserflo Microshunt (PMS) implantation combined with cataract surgery in open-angle glaucoma (OAG) patients. Retrospective, open-label study conducted on insufficiently controlled OAG patients, who underwent a PMS implant procedure with mitomycin-C 0.2%, either alone or in combination with cataract surgery, and were followed for at least 12 months. Success was defined as an intraocular pressure (IOP) ≤ 18 mmHg and a reduction of at least 20% without (complete) or with (qualified) hypotensive medication. Fifty-eight eyes were included in the study, 35 eyes underwent PMS alone and 23 underwent PMS + Phaco. In the overall study sample, mean IOP was significantly lowered from 21.5 ± 3.3 mmHg at baseline to 14.6 ± 3.5 mmHg at month 12 (p < 0.0001). The IOP was significantly reduced in both groups; p < 0.0001 each, respectively. Ocular hypotensive medication was significantly reduced (p < 0.0001) in both groups. No significant differences were observed in IOP lowering or medication reduction between groups. At month 12, 62.1% eyes were considered as complete success and 82.8% eyes as qualified success. The most common adverse events were device close-to-endothelium, conjunctival fibrosis, and wound leakage. PMS, either alone or in combination with phacoemulsification, may be considered as a valuable option for treating OAG patients.

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Section: Discussionmentioning

confidence: 96%

Clinical outcomes of combined Preserflo Microshunt implantation and cataract surgery in open-angle glaucoma patients

Martínez-de-la-Casa

Sáenz-Francés

Morales-Fernández

et al. 2021

Sci Rep

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“…Currently, the most effective topical treatments, such as topical prostaglandins and beta-blockers, have been shown to lower IOP by 28–33% [ 21 ]. The XEN-implant, one of the most common minimally invasive glaucoma surgery (MIGS) procedures, has been shown to reduce IOP reduction by approximately 29% [ 14 ]. Our study shows that MP-TSCPC reduced IOP by 30–35%.…”

Section: Discussionmentioning

confidence: 99%

“…This study is part of the Erasmus Glaucoma Cohort Study, an ongoing prospective study started in 2017. It includes all patients with glaucoma that visited the outpatient clinic of the Ophthalmology Department of the Erasmus Medical Centre, Rotterdam, The Netherlands, since January 2015 (that is, partially retrospective) [ 14 ]. For the purpose of this study, we included all patients who underwent MP-TSCPC between November 2017 and June 2021.…”

Section: Methodsmentioning

confidence: 99%

Efficacy and Safety of Micropulse Transscleral Cyclophotocoagulation

Vries

Pals

Poelman

et al. 2022

JCM

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Background: Early studies have shown that micropulse transscleral cyclophotocoagulation (MP-TSCPC) might be an effective and safe treatment option for lowering intraocular pressure (IOP). These studies were, however, somewhat limited, in particular by their retrospective nature and the length of follow-up. Therefore, we assessed the efficacy and safety of this novel treatment in a large cohort for up to 4 years. Methods: We performed a prospective cohort study, including all patients who were treated with MP-TSCPC since November 2017. The primary outcome was a reduction of IOP and the number of IOP-lowering medications. Results: The mean ± standard deviation baseline IOP and number of IOP-lowering medications were 26.6 ± 10.8 mmHg and 3.3 ± 1.3. IOP was reduced by 8.2 ± 7.9 (31.8% reduction), 6.9 ± 8.7 (28.1% reduction), and 7.1 ± 8.4 (30.2% reduction) mmHg after 6, 12, and 24 months, respectively (p < 0.001). The mean postoperative number of IOP-lowering medications was significantly reduced after 6 months by 0.6 ± 1.5 (p = 0.002) but was not significantly different after 12 or 24 months. Oral acetazolamide was significantly reduced from 28 (29%) eyes before treatment, to 9 (9%) at the last follow-up visit (p < 0.001). No major complications were observed after treatment. Conclusions: MP-TSCPC is a safe and effective treatment option for lowering IOP, but only reduced IOP-lowering medications in the first 6 months after treatment. However, MP-TSCPC is especially effective in getting patients off oral IOP-lowering drugs.

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“…A meta-analysis of 10 studies and 1117 eyes showed the superiority of stand-alone XEN45 implantation compared with combination with phacoemulsification (XEN45±PHACO) up to 6 months after surgery 16. Another meta-analysis published in the same year, in which 19 studies and 2215 eyes were included, concluded that there is no difference in the effect on IOP reduction between the procedure alone and the XEN45+PHACO at 2 years 17…”

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confidence: 99%

3-Year Outcomes of XEN Implant Compared With Trabeculectomy, With or Without Phacoemulsification for Open Angle Glaucoma

Marcos-Parra

Mendoza-Moreira

Moreno-Castro

et al. 2022

Journal of Glaucoma

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Précis: Trabeculectomy (TRAB) surgery reduces the intraocular pressure (IOP) more than the XEN45 implant over 3 years. There is no difference in the number of antiglaucoma medications between the 2 procedures. The decision to perform either TRAB or XEN45 implantation must be evaluated on a case-by-case basis, taking into account the high rate of needling of the XEN45. Purpose: The aim of this study was to compare the differences between the efficacy and safety of the XEN45 implant and TRAB, either alone or in combination with phacoemulsification (PHACO), in patients with open angle glaucoma (OAG) at 36 months. Methods: A retrospective, single-center and comparative study conducted on OAG patients who underwent XEN45 implantation or TRAB from 2016 to 2018. Patients were divided into 4 groups: group 1 (XEN45 alone), group 2 (XEN45+PHACO), group 3 (TRAB alone), and group 4 (TRAB+PHACO). For statistical purposes, groups 1 and 2 were combined (XEN45 implant), whereas groups 3 and 4 were also combined (TRAB surgery). IOP, number of glaucoma medications, and adverse events were evaluated. The main outcome measure was the reduction in IOP at 36 months postoperatively. Results: One hundred thirty-four patients (134 eyes; 63 XEN45 and 71 TRAB) were included. The mean (95% confidence interval) IOP reduction at the end of the study follow-up was −6.3 (−11.0 to −1.6 mm Hg, P=0.025, XEN45 alone), −8.9 (−11.0 to −6.8 mm Hg, P<0.001, TRAB alone), −2.5 (−4.5 to −0.4 mm Hg, P=0.019, XEN45+PHACO), and −5.6 (−7.7 to −3.4 mm Hg, P<0.001, TRAB±PHACO). The proportion of patients achieving an IOP≥6 and ≤16 mm Hg without treatment at the end of the 36-month follow-up were 50.8% (32/63) in the XEN45 implant and 49.3% (35/71) in the TRAB surgery group, P=0.863. The mean number of glaucoma medications was significantly reduced in all the study groups. The needling rate was 19% in XEN45 versus 5.6% in the TRAB group (P=0.030), and 2.81% and 36.6% of eyes in the TRAB group presented anterior chamber flattening and hyphema, respectively. Conclusions: TRAB surgery lowered IOP significantly more than XEN45 implant with or without phacoemulsification over 3 years and had a significantly lower need for additional needling surgery. Both procedures reduced glaucoma medications to a similar rate. These findings are relevant to the informed consent process and patient decisions for one procedure over the other.

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Efficacy of the XEN-Implant in Glaucoma and a Meta-Analysis of the Literature

Cited by 18 publications

References 32 publications

Clinical outcomes of combined Preserflo Microshunt implantation and cataract surgery in open-angle glaucoma patients

Clinical outcomes of combined Preserflo Microshunt implantation and cataract surgery in open-angle glaucoma patients

Efficacy and Safety of Micropulse Transscleral Cyclophotocoagulation

3-Year Outcomes of XEN Implant Compared With Trabeculectomy, With or Without Phacoemulsification for Open Angle Glaucoma

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