Influence of Mitomycin C on the Therapeutic Success of Stand-Alone Xen45 Gel Stents and Its Combination with Cataract Surgery in Open-Angle Glaucoma Patients

Abstract

Purpose Minimally invasive glaucoma surgery (MIGS), like Xen45 gel stents, is known as effective therapy in lowering intraocular pressure (IOP); however, fibrotic reactions are a common problem in postoperative management. It was the aim of this study to investigate the therapeutic success of Xen45 gel stents as a stand-alone technique (Xen) and combined with cataract surgery (XenPhaco), and with antimetabolites (mitomycin C, MMC) in open-angle glaucoma patients. Methods Retrospective analysis was performed of 199 eyes of 177 glaucoma patients of the Department of Ophthalmology, University of Erlangen Nürnberg, and from the Erlangen Glaucoma Registry (NCT00494923; ISSN 2191-5008, CS-2011) who underwent implantation of a Xen45 gel stent. Therapeutic success was defined as IOP reduction of ≥ 20% on the same or less anti-glaucomatous medication after 12 months compared to preoperative and without any additional glaucoma-related surgery (except bleb needling). IOP reduction, reduction in local anti-glaucomatous eye drops, and intra- and postoperative complications were monitored. Results Stand-alone Xen45 gel stent: therapeutic success was reached in 39% (–MMC) and 55% (+MMC). Failure rate was 61% (–MMC) and 45% (+MMC). XenPhaco: therapeutic success was achieved in 57% (–MMC) and 46% (+MMC). Failure rate was 43% (-MMC) and 54% (+MMC). Data were not different for group and subgroup analyses (p > 0.05). Conclusions The use of MMC seemed to increase the therapeutic success rate after stand-alone Xen45 gel stent implantation and combined with cataract surgery, yet statistical significant was not reached.

A case of mitomycin C toxicity after XEN gel stent implantation with the XEN air technique in a glaucoma patient

“…MMC remains the most frequently used agent due to its reasonable efficacy in preventing fibrosis. An increased therapeutic success rate was reported after XEN implantation by decreasing fibrotic reactions [ 9 ]. Subconjunctival injection of 0.01% MMC reduced the rate of needling to 30.7% [ 2 ].…”

Defining the role of ab externo Xen gel stent in glaucomatous eyes with prior failed surgical intervention

“…The stent is 6 mm long with a 45-μm lumen and is designed to limit early postoperative hypotony, a significant risk of traditional filtering surgery. The procedure requires use of mitomycin-C (MMC) to reduce postoperative fibrosis [ 4 , 5 ]. The Xen stent is approved by the US Food and Drug Administration for ab interno placement, but in an effort to minimize invasiveness, optimize efficacy, and improve safety as well as ease implantation, an ab externo approach has been developed and adopted by many surgeons.…”