The Outcomes of XEN Gel Stent Implantation: A Systematic Review and Meta-Analysis

Chen, Xuanzhu; Liang, Zhiqiao; Yang, Kangyi; Lv, Kun; Ma, Yao; Li, Meng-yang; Wu, Huijuan

doi:10.3389/fmed.2022.804847

Cited by 18 publications

(21 citation statements)

References 97 publications

(182 reference statements)

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“…A systematic review of XEN stent and cataract surgery revealed an average reduction of 1.86 drops with a range of 1.4 to 3.1. 35 In addition, a meta-analysis of iStent implants revealed an average medication reduction of 1.2 for a follow-up time between 36 and 60 months. 36 Our study demonstrated an average number of glaucoma medication reduction of 1.2, with XEN being significantly different than the other two stent groups with a reduction of 2.8 number of medications compared to 0.4 in the iStent group and the Hydrus group ( Table 4 ).…”

Section: Discussionmentioning

confidence: 99%

“…34 Lastly, a systematic review of XEN gel stent found an overall IOP reduction of 35% across their meta-analysis. 35 We Mean (SD) − found that patients who underwent either of the three stent implantations had an average of 2.2 mmHg drop in IOP, or a 12.9% decrease, within 12 to 18 months. Notably, with a baseline IOP of 17.1 mmHg and a final average number of glaucoma drops of 1.5, it is unsurprising there was a modest IOP reduction.…”

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confidence: 99%

“…Altogether, similarly to IOP reduction, number of glaucoma medication reduction across the literature post iStent, Hydrus, and XEN exhibited similar results to our findings, with an average of one-to-three medications reduced after implantation. [31][32][33][34][35] Research on VF stability after MIGS is forthcoming. A retrospective study of XEN implants found MD to be stable across various types of glaucoma 12 months after surgery.…”

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confidence: 99%

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Clinical and Visual Field Outcomes Following Minimally Invasive Glaucoma Surgery Combined with Cataract Surgery

Turner¹,

Taha²,

Yonamine³

et al. 2022

OPTH

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Purpose To determine the change in Humphrey visual field and clinical parameters after minimally invasive glaucoma surgery combined with cataract surgery. Patients and Methods Patients undergoing minimally invasive glaucoma surgery combined with cataract surgery in a multicenter retrospective case series between 2013 and 2021 with reliable preoperative and 12 to 18 month postoperative visual field measurements were included. Devices included iStent, XEN, and Hydrus. Clinical parameters were compared with a generalized linear model with generalized estimating equations between preoperative and postoperative visits including best corrected visual acuity, intraocular pressure, number of glaucoma medications and visual fields. Visual field metrics included mean deviation (MD), pattern standard deviation (PSD), visual field index (VFI), and Collaborative Initial Glaucoma Treatment Study (CIGTS) score of total deviation probability and pattern deviation probability. Results Forty-four eyes from 39 patients were included. During the follow up period, visual acuity improved from 0.23±0.17 to 0.10±0.14 logMAR (mean ± standard deviation, p <0.001), number of glaucoma medications was reduced from 2.68±1.06 to 1.46±1.32 ( p <0.001), and intraocular pressure decreased from 17.08±4.23 mmHg to 14.92±3.13 mmHg ( p =0.003). Differences across devices were negligible. The only significant difference was a greater reduction in number of glaucoma medications in the XEN group ( p <0.001). There were no significant changes in the global parameters of VFI, MD, PSD, or CIGTS. Conclusion Overall, minimally invasive glaucoma surgery combined with cataract surgery appears to be effective at stabilizing visual field function, reducing intraocular pressure, reducing number of glaucoma medications, and improving visual acuity over a 12 to 18 month follow-up period across MIGS devices.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

See 1 more Smart Citation

Clinical and Visual Field Outcomes Following Minimally Invasive Glaucoma Surgery Combined with Cataract Surgery

Turner¹,

Taha²,

Yonamine³

et al. 2022

OPTH

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“…In comparison, literature reports mean IOP reductions of >20% by 12 months, generally ranging from 25-47% in XEN stents implanted both with and without concurrent phacoemulsification. 1,[11][12][13][14]…”

Section: Discussionmentioning

confidence: 99%

Ab Interno XEN Gel Stent Implantation in Eyes with Previous Tube Shunt Surgery

Xu¹,

Chan²

2022

OPTH

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Purpose After tube shunt surgery, many factors may contribute to insufficient filtration over time, prompting further intervention to achieve optimal intraocular pressure (IOP) control. This study explores whether ab interno XEN gel stent implantation could be a viable approach in eyes that need further IOP reduction after tube shunt surgery. Methods This is a retrospective, single-surgeon case series on ab interno XEN45 gel stent implantation in eyes that had previous tube shunt surgery. Main outcome measures were IOP and number of glaucoma medications at the pre-operative visit, post-operative week (POW) 1, and post-operative month (POM) 1, 3, 6, and 12. Adverse events and further interventions were noted. Surgery outcome was qualified as absolute success (IOP ≤ 18mmHg or ≥ 20% IOP reduction without glaucoma medications), qualified success (IOP ≤ 18mmHg or ≥ 20% IOP reduction with glaucoma medications), or failure (IOP > 18mmHg and < 20% IOP reduction with maximum tolerated glaucoma medications). Results 7 eyes from 6 patients were included in this study. IOP was reduced from 23.9 ± 5.3 mmHg (mean ± standard deviation) pre-operatively to 14.0 ± 5.3 mmHg at POM12 (p < 0.05). Number of glaucoma medications was reduced from 4.3 ± 1.3 pre-operatively to 1.6 ± 1.6 at POM12 (p < 0.05). Hypotony and choroidal effusion were noted in one case which resolved before POM1. Bleb needling was required in 3 of the 7 eyes (43%), with one eye requiring needling twice. By POM12, 2 of 7 eyes (29%) achieved absolute success, 4 eyes (57%) qualified success, and 1 eye (14%) was qualified as failure. Conclusion Ab interno XEN gel stent can effectively reduce IOP and number of glaucoma medications after failed tube shunt surgery. Nonetheless, further interventions such as bleb needling may still be required to optimize IOP control.

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“…However, retrospective studies of patients receiving MicroShunt implants who specifically had prior failed subconjunctival glaucoma surgery reported higher rates of choroidal effusion development, ranging from 9.6 to 12.9% [24,25], suggesting that a more complex ocular history may increase the risks of postoperative complications such as choroidal effusions, even with minimally invasive approaches. Several recent studies have also reported on the incidence of choroidal effusions in patients receiving the XEN45 gel stent, with ranges between 1.3 and 19.8% depending on the technique used [26,27,28 ▪ ,29,30].…”

Section: Risk Factors For Choroidal Effusion Developmentmentioning

confidence: 99%

Risk factors and management of choroidal effusions

Ying

Sidoti

Panarelli

2022

Current Opinion in Ophthalmology

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Purpose of reviewChoroidal effusions are recognized as a common early postoperative complication of glaucoma surgery, and although often benign, they may cause significant ocular morbidity. This article aims to summarize current research on the risk factors and management of choroidal effusions.Recent findingsGlaucoma drainage device (GDD) implantation and trabeculectomy are the most commonly performed surgeries for the management of moderate to severe glaucoma. Common postoperative complications of these procedures include hypotony and the development of choroidal effusions. Choroidal effusions have recently been associated with the oral administration of certain drugs, including select monoclonal antibody, antiseizure and bisphosphonate medications. Risk factors for effusion development include specific patient characteristics such as pseudoexfoliative glaucoma, older age and hypertension. Although choroidal effusions typically resolve with medical therapy alone, surgical intervention may be required. Various methods of surgical intervention, such as surgical drainage or GDD tube ligation, can be utilized to treat choroidal effusions when conservative management with medical treatment fails, but themselves carry alternative risks that must be considered.SummaryMinimizing the incidence and duration of hypotony following ophthalmic surgery and careful monitoring of patients starting certain oral medications are important in limiting the occurrence of choroidal effusions. Risk factors for choroidal effusions have been recently identified in the literature. A better understanding of these risk factors, as well as the outcomes of choroidal effusion management, can help to reduce the occurrence of effusions overall and minimize ocular morbidity.

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The Outcomes of XEN Gel Stent Implantation: A Systematic Review and Meta-Analysis

Cited by 18 publications

References 97 publications

Clinical and Visual Field Outcomes Following Minimally Invasive Glaucoma Surgery Combined with Cataract Surgery

Clinical and Visual Field Outcomes Following Minimally Invasive Glaucoma Surgery Combined with Cataract Surgery

Ab Interno XEN Gel Stent Implantation in Eyes with Previous Tube Shunt Surgery

Risk factors and management of choroidal effusions

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