XEN45 Gel Stent implantation in eyes with primary open angle glaucoma: A study from a single hospital in Taiwan

Chao, Yu Jang; Ko, Yu Chieh; Chen, Mei Ju; Lo, Kang-Jung; Chang, Yu Fan; Liu, Catherine Jui Ling

doi:10.1097/jcma.0000000000000430

Cited by 5 publications

(25 citation statements)

References 34 publications

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“…The qualified success rate was 60.0-90.2% after 1 year (n = 4) and 34.0-86.0% after 2 years (n = 3). If the absolute IOP threshold was decreased to 18 mmHg (13,18,19,28,29,36,43,50,54), the qualified success rate was 25.0-90.6% and the complete success rate was 15.4-76.7% at the last follow-up. In a 4-year follow-up study (26), which was the longest follow-up period, XEN with an inner diameter of 63 µm was applied in patients with open-angle glaucoma.…”

Section: Overall Resultsmentioning

confidence: 99%

“…Gabbay et al (50) hold a similar opinion that more postoperative interventions were conducted for the non-Caucasian group. Chao et al (28) demonstrated that a reoperation rate as high as 45.9% may be related to patients of Chinese ethnicity. Previous studies (92)(93)(94) have reported that Asian and Black/African ethnicities exhibit an increased risk of failure with trabeculectomy.…”

Section: Discussionmentioning

confidence: 99%

“…The aim of most studies was to determine the postoperative course after XEN implantation in Caucasian patients with glaucoma. However, a few studies focused on Asian patients (9,20,(27)(28)(29) and black or Afro-Latino patients (30,31) with glaucoma. The flow chart of the search results is shown in Figure 1.…”

Section: Literature Searchmentioning

confidence: 99%

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

et al. 2022

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PurposeXEN gel stents are used for the treatment of open-angle glaucoma (OAG), including primary and secondary glaucoma that are uncontrolled by previous medical therapy and cases with previous failed surgery. Our aim was to systematically review of the clinical data of currently published ab-interno XEN gel stents with an emphasis on intraocular pressure (IOP), antiglaucoma medication outcomes, and safety profiles.MethodsWe analyzed all of the publications (MEDLINE, EMBASE, Cochrane Library) on the ab-interno XEN gel stent to evaluate the reduction in IOP and antiglaucoma medications following the procedure. The primary outcomes measured for the meta-analysis were reduction in IOP and anti-glaucoma medications. The secondary outcome were adverse events. For each study, we used a random effects analysis model to calculate the mean difference and 95% confidence intervals for the continuous results (reduction in IOP and antiglaucoma medications) using the inverse variance statistical method.ResultsFive hundred twenty-seven articles were checked and 56 studies were found to be relevant with a total of 4,410 eyes. There was a significant reduction in IOP as well as in the number of medications required in patients treated with ab-interno XEN implant either alone or combined with cataract surgery. This new treatment for various types of glaucoma reduced the IOP by 35% to a final average close to 15 mmHg. This reduction was accompanied by a decrease in the number of antiglaucoma medications in all the studies, approximately 2 classes of medication at the price of more needlings. The overall complete success rate was 21.0–70.8% after 2 years using strict criteria originally designed to record success rate in filtration surgery. The incidence of complications vision-threatening was low at <1%.ConclusionsXEN gel stent was effective and safe for primary and secondary OAG. Further studies should be performed to investigate the impact of ethnicity on the success and failure rate after XEN implantation.

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Section: Overall Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…The weighted mean Forty-five studies (n = 3122 total eyes) reported 12-month outcomes with complete pre-and postoperative IOP and medication use. 4,5,[10][11][12]15,19,20,25,[27][28][29][30][31][32][33][35][36][37][38][39][40][42][43][44][45][46][47][48][51][52][53]55,[57][58][59][60][62][63][64][65][66][67][68] In these studies, the median number of eyes followed was 52 (range, 12-242) and median age was 72.2 years (range, 53.4-80.9). The weighted mean preoperative IOP was 22.2 mm Hg on 2.5 glaucoma medications, and the weighted mean postoperative IOP was 14.2 mm Hg on 0.7 glaucoma medications.…”

Section: Efficacy Outcomesmentioning

confidence: 97%

“…5,10,11,15,21,22,29,31,37,40,43,44,50,54,55,58,63,69 In 41 retrospective studies representing 3111 total eyes, a median of 52 eyes (range, 13-242) were followed for a median of 12 months (range, 6-36). 4,12,16,19,20,[24][25][26][27][28]30,[32][33][34][35][36]38,39,41,42,[45][46][47][48][49][51][52][53][56][57][58][59][60][61]…”

Section: Efficacy Outcomesmentioning

confidence: 99%

Intraocular Pressure and Medication Changes Associated with Xen Gel Stent: A Systematic Review of the Literature

Panarelli¹,

Vera²,

Sheybani³

et al. 2023

OPTH

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The Xen gel stent (Allergan Inc, an AbbVie company; Dublin, Ireland) was conceived as an option for patients requiring modest IOP reduction but for whom trabeculectomy was not yet indicated. As with any glaucoma surgery, establishing criteria for patient selection and identifying factors that contribute to a high likelihood of success are important. To help guide clinical decisionmaking, a systematic review of published studies on the gel stent was performed, with the goal of understanding postoperative outcomes based on clinical and patient factors. Results were organized around a series of pertinent clinical questions based on scenarios encountered in clinical practice. Criteria for including studies were intentionally broad, with the objective of simulating the diverse population of glaucoma patients encountered in real-world practice. Outcomes for IOP and medication reduction postoperatively were assessed in various analyses, including in eyes with various glaucoma types and severity; in eyes naïve to surgery as well as those with a history of prior incisional glaucoma surgery; and when surgery was performed as a standalone procedure or at the time of cataract surgery. The results of each of the various analyses were consistent in demonstrating that successful gel stent surgery achieved a postoperative IOP of approximately 14.0 mm Hg and reduction to fewer than 1 glaucoma medication. Additional data are shown on outcomes by method of implant (ab interno vs ab externo); intraoperative use of antifibrotics; and rates of needling in published studies.

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The efficacy of XEN gel stent implantation in glaucoma: a systematic review and meta-analysis

et al. 2022

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Background Xen is a device for minimally invasive glaucoma surgery, and is used to treat POAG, pseudoexfoliative or pigmentary glaucoma, as well as refractory glaucoma. The efficacy of XEN in treating glaucoma remains to be confirmed and clarified. Hence, we conducted a systematic review and meta-analysis to examine the efficacy and associated complication of XEN implantations. Methods We conducted a literature search in PubMed, EMBASE, the Cochrane Library of Systematic Reviews, Web of Science, China National Knowledge Infrastructure, WanFang and SinoMed databases to identify studies, published before May 15, 2021, which evaluated XEN in glaucoma, and parameters for measurements included intra-ocular pressure (IOP), number of anti-glaucoma medications (NOAM), and bleb needling rate. We compared the measurements of XEN-only procedure between phaco-XEN and trabeculectomy, and we also did sub-analysis based on time points, glaucoma types, ethnics, etc. Sensitivity analyses and publication bias were conducted for evaluating bias.This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA 2020) reporting guideline. Results We identified 78 eligible studies, analysis revealed obvious IOP reduction after XEN stent implantation (SMD: 1.69, 95% CI 1.52 to 1.86, p value < 0.001) and NOAM reduction (SMD: 2.11, 95% CI 1.84 to 2.38, p value < 0.001). Sub-analysis showed no significant difference with respect to time points, ethnicities, and economic status. No significant difference was found between XEN treatment effect on POAG and PEXG eyes and between pseudo-phakic and phakic eyes. Also no significant difference was found between XEN and phaco-XEN surgery in terms of IOP after surgery (SMD: -0.01, 95% CI -0.09 to 0.08, p value 0.894). However, NOAM (after publication bias correction) and bleb needling rate (RR: 1.45, 95% CI 1.06to 1.99, p value 0.019) were lower in phaco-XEN group compared to XEN only group. Compared to trabeculectomy, XEN implantation had similar after-surgery IOP, however bleb needling rate (RR: 2.42, 95% CI 1.33 to 4.43, p value 0.004) was higher. Conclusion Our results confirmed that XEN is effective in lowering both IOP and NOAM till 48 months after surgery. It is noteworthy that XEN implantation leads to higher needling rate, compared to phaco-XEN or trabeculectomy. Further research, studying complications of XEN on non-European ethnicities, especially on Asian, are in urgent need before XEN is widely applied.

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XEN45 Gel Stent implantation in eyes with primary open angle glaucoma: A study from a single hospital in Taiwan

Cited by 5 publications

References 34 publications

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

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

Intraocular Pressure and Medication Changes Associated with Xen Gel Stent: A Systematic Review of the Literature

The efficacy of XEN gel stent implantation in glaucoma: a systematic review and meta-analysis

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