In vivo confocal microscopy: qualitative investigation of the conjunctival and corneal surface in open angle glaucomatous patients undergoing the XEN-Gel implant, trabeculectomy or medical therapy

Abstract

Purpose: Assessing the quality of the ocular surface by in vivo scanning laser confocal microscopy (IVCM) in primary open angle glaucoma (POAG) patients treated by Xen 45 Gel Stent, medical therapy and trabeculectomy. Methods: Retrospective, single-center, single-masked, comparative study including 60 eyes of 30 patients (mean age 61.16 ± 10 years) affected by POAG. Eyes were divided into 3 groups: Group 1 eyes underwent the Xen 45 Gel Stent procedure, Group 2 eyes were under medical therapy, Group 3 eyes were surgically treated by trabeculectomy. All patients underwent HRT II IVCM analysis of cornea, limbus, conjunctiva, sub-tenionian space and sclera. Results: The Xen 45 Gel stent, if properly positioned in the sub-conjunctival space preserves goblet cells and limits ocular surface inflammation. Regular corneal epithelial cells with micro-cysts, and normo-reflective sub-epithelial nerve plexus are documented by IVCM. In sub Tenon's implants an alternative lamellar intra-scleral filtration is detectable. Combined surgical procedures show a noticeable number of inflammatory cells with rare micro-cysts. Post-trabeculectomy inflammatory reaction is more evident than Xen 45 Gel Stent associated surgical procedures, but less than medical therapy where a conspicuous presence of Langerhans cells, peri-neural infiltrates, marked loss of goblet cells and fibrosis is visible. Conclusion: Ocular surface inflammation was more notable in topical therapy than after trabeculectomy, which itself causes more inflammation than XEN Gel stents.

Risk of Glaucoma in Patients Receiving Hemodialysis and Peritoneal Dialysis: A Nationwide Population-Based Cohort Study

“…Trabeculectomy and Ahmed valve implantation [ 39 ] are surgical options for medically uncontrolled IOP. The Xen Gel Stent, an ab interno minimally invasive glaucoma surgery, offers an alternative option for mild to moderate OAG with the advantage of lower ocular surface inflammation compared to topical therapy and trabeculectomy [ 40 ].…”

Effects of Combinations of Ophthalmic Viscosurgical Devices and Suction Flow Rates on the Corneal Endothelial Cell Damage Incurred during Phacoemulsification

“…In ophthalmic surgery, various methods for assessing surgical invasion have been reported [23,24]. We observed the behavior of OVDs during phacoemulsification using the "slit side view" method and fluorescein-stained OVDs, which enabled viewing of the movement of OVDs intraoperatively and the fluid dynamics in the anterior chamber [25].…”

Tenon Capsule Grafting versus Autologous Scleral Graft in Ahmed Glaucoma Valve Surgery

“…e limitations of this study were a relatively small number of patients and short-term follow-up. Long-term ocular surface changes also can be studied in the future like other studies that clarified the long-term ocular surface changes induced by various treatment choices in POAG patients describing the potential of the Xen 45 Gel Stent in preserving ocular surface integrity and the potentiality of improved outcomes for any subsequent surgeries [17]. In addition, more study for morphological changes will be important like the study which clarified the role of intraoperative real-time image-guided technique using intraoperative ultrasound biomicroscopy and optical coherence tomography and represented that it will be the future, even if it still needs more efforts to make the instrumentation functional and simple to use [18].…”