XEN Gel Stent versus trabeculectomy: Short-term effects on corneal endothelial cells

Abstract

Purpose To compare the short-term changes in corneal endothelial cells after trabeculectomy or XEN Gel Stent implantation. Design Prospective, interventional, comparative study. Methods Changes in corneal endothelium in patients that underwent XEN Gel Stent implantation or trabeculectomy were prospectively evaluated. Eighty eyes of 62 diagnosed with open-angle glaucoma were divided into two the trabeculectomy and XEN Gel Stent groups. Corneal specular microscopy was performed at the central cornea using a noncontact specular microscope preoperatively and 3 months after surgery. Results The baseline mean corneal endothelial cell density in the trabeculectomy group was 2390.3 ± 324.8 cells/mm2, and this was significantly reduced to 2148 ± 352.5 cells/mm2 3 months after surgery, representing a cell loss of 10.0% (p < 0.001). The baseline mean corneal endothelial cell density in the XEN Gel Stent group was 2156.2 ±559.7 cells/mm2, and this was significantly reduced to 2098.4 ± 556.2 cells/mm2 3 months after surgery, representing a cell loss of 2.1% (p = 0.002). The corneal endothelial cell density change rate of the trabeculectomy group (−10.0% ± 9.7%) was statistically higher than the XEN Gel Stent group (−2.1% ± 13.8%) (p = 0.002). A statistically significant difference was observed in the trabeculectomy group between the baseline and postoperative values in the coefficient of variation (p = 0.029). Conclusion Trabeculectomy caused more endothelial cell damage than XEN Gel Stent implantation in the short-term follow-up period. The XEN Gel Stent may be the treatment of choice in patients with a significantly low preoperative corneal endothelial cell density.

Combined and stand‐alone XEN 45 gel stent implantation: 3‐year outcomes and success predictors

“…Yet, like in any bleb‐creating procedure, serious complications associated with permanent visual loss following XEN surgery exist and were also described by other groups (Lim & Lim 2018). Additionally, despite reassuring reports by Olgun et al (2020) and Gillmann et al (2020), the long‐term effect of XEN 45 gel stents on the endothelial cell density remains unconfirmed.…”

“…This was further highlighted by the case of late hypotony following the sudden reduction in conjunctival resistance after an otherwise uncomplicated needling procedure. Nevertheless, XEN 45 gel stent implantation is less prone to hypotony than traditional filtering surgery (Olgun et al 2020). Yet, like in any bleb‐creating procedure, serious complications associated with permanent visual loss following XEN surgery exist and were also described by other groups (Lim & Lim 2018).…”

XEN Glaucoma Implant for the Management of Operated Uncontrolled Glaucoma: Results and Complications during a Long-Term Follow-Up

“…is advantage makes its use comparable with trabeculectomy, which is considered as the gold standard in glaucoma surgery, but is burdened with a high risk of complications often resulting in unpredictable outcomes and deterioration of vision [10]. Studies that compared the two treatments have demonstrated similar hypotensive efficacy with a better safety profile for XEN [11][12][13].…”

XEN Glaucoma Implant for the Management of Glaucoma in Naïve Patients versus Patients with Previous Glaucoma Surgery

“…However, in contrast to trabeculectomy, the advantages of XEN Gel Stent implants include microinvasive ab interno/ab externo access, sparing of the sclera and conjunctiva, obviating the need for iridectomy and sutures, and a shorter procedure time. Studies that compared the two treatments demonstrated similar hypotensive efficacy with a better safety profile for XEN [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ].…”