XEN Gel Implant: a new surgical approach in glaucoma

Chaudhary, Ankita; Salinas, Lauriane; Guidotti, Jacopo; Mermoud, André; Mansouri, Kaweh

doi:10.1080/17434440.2018.1419060

Cited by 74 publications

(86 citation statements)

References 59 publications

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“…In the absence of a standard protocol for bleb management, a variety of interventions have been used postoperatively, including reintroduction of antiglaucoma medications in case of IOP increase. The needling rate with the XEN Gel Stent varies widely, [15] from\ 3% with MMC [16,17] to approximately 50% when performed without antimetabolites [18] or with MMC in a few cases [3]. A recent retrospective study reported that needling with 5-FU after XEN implantation resulted in a substantial IOP-lowering effect (preneedling IOP of 26.2 ± 9.5 mmHg and postneedling IOP at last follow-up of 15.4 ± 3.7 mmHg) [19].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of postoperative management with 5-fluorouracil injections after XEN Gel Stent implantation

et al. 2019

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Purpose To evaluate the efficacy of postoperative management with 5-fluorouracil injections after XEN Gel Stent implantation. Methods Prospective real-world evidence study included 39 eyes (of 36 patients) with primary openangle glaucoma without previous glaucoma surgery and with uncontrolled intraocular pressure (IOP), glaucoma progression, or intolerance to IOP-lowering therapy. Patients underwent mitomycin C-augmented XEN implantation either as a stand-alone procedure or combined with cataract extraction. 5-Fluorouracil subconjunctival injections were a first-choice therapy for bleb failure and were administered according to predetermined criteria (analogous to pro re nata regimen in age-related macular degeneration treatment). Primary outcome was unqualified success, defined as postoperative IOP \ 18 mmHg and[ 20% reduction from medicated baseline without any antiglaucoma medications and no detected glaucoma progression. Results At median follow-up of 8 months (range 3-24 months), IOP decreased from a medicated baseline value of 23 mmHg (95% CI 21-24 mmHg) to 13 mmHg (95% CI 12-15 mmHg) and number of medications decreased from 3 (95% CI 2-3) to 0 (p \ 0.0001 for both). Median number of 5-fluorouracil injections per eye was 3 (95% CI 2-3), and median time to first injection was 0.5 months (95% CI 0.25-3 months) after surgery. Thirteen eyes (33.3%) underwent C 1 needling, and surgical revision was performed in three cases (7.7%). The primary outcome measure, which allows performing additional procedures, was achieved in 27 eyes (69%). Conclusions 5-Fluorouracil subconjunctival injections are safe and effective in postoperative management of bleb failure after XEN implantation and represent a viable alternative to other methods.

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Section: Discussionmentioning

confidence: 99%

Efficacy of postoperative management with 5-fluorouracil injections after XEN Gel Stent implantation

et al. 2019

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“…It consists of a 6 mm long flexible tube with a 45 μm diameter lumen made of porcine cross-linked collagen. The device is based on the principles set in the Hagen-Poiseuille equation, establishing that a longer thinner tube will provide more resistance to flow than a shorter and wider one [21].…”

Section: Xen 45 Gel Stentmentioning

confidence: 99%

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

et al. 2020

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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.

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“…On the other hand, in eyes with XEN implantation there is minimal manipulation of subconjunctival and episcleral tissues and therefore may require needling in the immediate postoperative period. The cause of high IOP on day 1 after surgery has been postulated to be due to blockage of the XEN implant by Tenon, blood, or exudates but has not been studied in detail [2,13].…”

Section: Discussionmentioning

confidence: 99%

“…Minimally invasive glaucoma surgeries (MIGS) aim to provide a safer and less-invasive alternative to incisional glaucoma surgeries for the control of intraocular pressure (IOP) [1,2]. At present, the XEN gel implant (Allergan, Dublin, CA) is the only Food and Drug Administration (FDA)-approved MIGS device that drains into the subconjunctival space and results in a bleb formation.…”

Section: Introductionmentioning

confidence: 99%