1
|
Tan JCK, Hashimoto Y, Gabrielle PH, Garcher CC, White A, Dunn H, Walland M, Wechsler D, Arnould L, Lawlor M. Outcomes and Baseline Predictors of Failure in Primary Standalone Xen45 Gel Stent versus Trabeculectomy for Glaucoma. Ophthalmol Glaucoma 2024:S2589-4196(24)00132-7. [PMID: 39004222 DOI: 10.1016/j.ogla.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/18/2024] [Accepted: 07/08/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE To compare safety, effectiveness, and baseline predictors of failure in standalone primary Xen45 gel stent (Xen) versus trabeculectomy (Trab) in glaucoma. DESIGN Retrospective study. SUBJECTS Subjects that underwent primary Xen or Trab augmented by mitomycin-C with at least 12 months follow-up. METHODS Multinational observational study of eyes in the Fight Glaucoma Blindness international registry MAIN OUTCOME MEASURES: The primary outcome was success at 12 months defined by intraocular pressure (IOP) reduction ≥ 20% from baseline and ≤ threshold IOPs of 15, 18, and 21 mmHg with (qualified) or without (complete) medications and without secondary glaucoma surgery. Multivariable mixed effects Cox regression models were used to identify risk factors for failure in each cohort. RESULTS A total of 701 eyes (Xen, 308; Trab, 393) of 596 subjects were included with baseline IOP being significantly higher (22.4 vs. 19.9 mmHg, P < 0.001) and baseline medications significantly lower in the Xen versus the Trab group (2.9 vs. 3.4, P < 0.001). Baseline visual field mean deviation was less severe in the Xen group (-9.47 vs. -13.04 dB, P < 0.001). The proportion of complete surgical success was significantly lower in the Xen versus Trab group across the 3 upper IOP limits at 12 months; 32% versus 52% at 15 mmHg, 37% versus 54% at 18 mmHg, and 39% versus 55% at 21 mmHg (P < 0.001). The incidence of postoperative numerical and symptomatic hypotony was lower in the Xen versus Trab group. In the Xen cohort, a higher failure rate was associated with Asian ethnicity (hazard ratio [HR], 1.97; 95% confidence interval (CI), 1.03-3.79) and use of oral acetazolamide at baseline (HR, 1.74; 95% CI, 1.13-2.70), whereas a lower failure rate was associated with diagnosis of ocular hypertension/open-angle glaucoma suspect (HR, 0.40; 95% CI, 0.20-0.82) and secondary open-angle glaucoma (HR, 0.46; 95% CI, 0.26-0.82). Exposure to prostaglandin analog was associated with greater failure in the Trab group (HR, 2.66; 95% CI, 1.18-6.01). CONCLUSIONS There was significantly greater complete success at 12 months across all complete success definitions for Trab compared with Xen, whereas the rate of postoperative hypotony was significantly lower in the Xen group. Asian ethnicity and use of oral acetazolamide at baseline were associated with greater failure in Xen, whereas exposure to prostaglandin analog was associated with greater failure in Trab patients. Such baseline predictors of success and failure may help guide patient selection for subconjunctival minimally invasive glaucoma surgery in patients undergoing surgical intervention. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Jeremy C K Tan
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia.
| | - Yohei Hashimoto
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | | | - Andrew White
- Centre for Vision Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Hamish Dunn
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Walland
- Glaucoma Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - David Wechsler
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Louis Arnould
- Department of Ophthalmology, Dijon University Hospital, Dijon, France; Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), Equipe d'Accueil 7460, Faculty of Health Sciences, Université de Bourgogne Franche-Comté, Dijon, France
| | - Mitchell Lawlor
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, Sydney Eye Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Bahlmann D, van Oterendorp C. [Glaucoma Filtration Surgery - Bleb-forming Procedures]. Klin Monbl Augenheilkd 2024; 241:863-880. [PMID: 38788734 DOI: 10.1055/a-2305-5053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Glaucoma filtration surgery has been a standard surgical therapy for decades. An increasing knowledge about wound healing processes in the eye, the introduction of antimetabolite treatment and continuous improvements of the surgical technique helped making trabeculectomy - the prototype filtration surgery - a very effective therapeutic tool. However, best results will only be regularly achieved with a high level of experience and time dedicated to postoperative follow-up. Furthermore, the potential for severe early and late complications still remains high. Thus, novel stent-based filtration surgery approaches, such as the Preserflo and the XEN shunt have been introduced. This review presents these three bleb-forming filtration procedures, covering the basic principles of surgical technique, data on effectivity as well as complications.
Collapse
|
3
|
Rauchegger T, Krause SM, Nowosielski Y, Huber AL, Willeit P, Schmid E, Teuchner B. Three-year clinical outcome of XEN45 Gel Stent implantation versus trabeculectomy in patients with open angle glaucoma. Eye (Lond) 2024; 38:1908-1916. [PMID: 38548944 PMCID: PMC11226636 DOI: 10.1038/s41433-024-03042-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/28/2024] [Accepted: 03/15/2024] [Indexed: 07/07/2024] Open
Abstract
OBJECTIVE To reliably compare the three-year clinical outcome and safety of XEN45 Gel Stent implantation (XEN) vs. trabeculectomy (TRAB) in patients with glaucoma. SUBJECT/METHODS We conducted a retrospective cohort study with patients with primary open angle or pseudoexfoliation glaucoma with uncontrolled intraocular pressure (IOP) undergoing XEN or TRAB at the Innsbruck University Clinic of Ophthalmology and Optometry, Austria and analysed changes in IOP, numbers of IOP-lowering medications, and complete surgical success (i.e., IOP ≤ 18 mmHg, ≥20% IOP reduction and not requiring IOP-lowering medication) up to 36 months postoperatively. RESULTS Between 2013 and 2019, we performed XEN Gel Stent implantation in 58 eyes and trabeculectomy in 84 eyes. From baseline to 36 months, mean IOP decreased from 23.4 to 13.8 mmHg (mean reduction 35%, 95% confidence interval 23-48%, p < 0.001) in the XEN group and from 25.1 to 11.2 mmHg (mean reduction 50%, 41-60%, p < 0.001) in the TRAB group. TRAB provided higher IOP reduction than XEN Gel Stent implantation at 12, 24, and 36 months (all p < 0.05). In XEN versus TRAB, IOP-lowering medication was required by 98.3% vs. 97.6% before surgery (p = 0.781), differed significantly at month 12 (43.2% vs. 2.0%, p < 0.001)but not at month 24 or 36. Complete surgical success was achieved in 40.0% vs. 62.8% at month 24 (adjusted odds ratio 2.70; 1.04-7.00, p = 0.040) and 27.3% vs. 56.8% at month 36 (4.36; 1.25-15.18, p = 0.021). CONCLUSION Compared to XEN, TRAB was associated with lower intraocular pressure, less IOP-lowering medication, and higher probability of achieving complete surgical success over a 36-month follow-up period.
Collapse
Affiliation(s)
- Teresa Rauchegger
- Department of Ophthalmology and Optometry, Medical University of Innsbruck, Innsbruck, Austria.
| | - Sarah-Maria Krause
- Department of Ophthalmology and Optometry, Medical University of Innsbruck, Innsbruck, Austria
| | - Yvonne Nowosielski
- Department of Ophthalmology and Optometry, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Lena Huber
- Department of Ophthalmology and Optometry, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Willeit
- Institute of Health Economics, Medical University of Innsbruck, Innsbruck, Austria.
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Eduard Schmid
- Department of Ophthalmology and Optometry, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara Teuchner
- Department of Ophthalmology and Optometry, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
4
|
Julio G, Larena R, Mármol M, Soldevila A, Canut MI, Pavan J, Barraquer RI. XEN45 Implant in Medically Controlled vs. Uncontrolled Eyes-Differential IOP Changes in Real-Life Conditions. J Clin Med 2024; 13:3406. [PMID: 38929940 PMCID: PMC11204868 DOI: 10.3390/jcm13123406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Background: To assess intraocular pressure (IOP) changes and complications after XEN45 implants in medically controlled eyes (MCE) vs. medically uncontrolled eyes (MUE). Methods: A retrospective study, in a tertiary referral hospital, on mild-to-moderate primary open-angle glaucoma (POAG) cases under topical medication, including 32 eyes with IOP < 21 mmHg (MCE group) and 30 eyes with IOP ≥ 21 mmHg (MUE group). The success criteria using Kaplan-Meier analysis was IOP < 21 mmHg without medications (complete success) or fewer drugs than preoperatively (qualified success) at the last visit, without new surgery or unresolved hypotony. Results: No significant preoperative differences were found between the groups. The mean IOP was 15.6 ± 3.8 mmHg in MCE and 15.1 ± 4.1 mmHg in the MUE group (p > 0.05; Mann-Whitney test) at the end of the follow-up (mean of 26.1 ± 15.6 months and 28.3 ± 15.3 months, respectively) (p = 0.414, Mann-Whitney Test). The device caused a significant IOP reduction at 24 h in both groups. Thereafter, the MCE group significantly tended to increase IOP, recovering baseline values at 1 month and maintaining them until the end of the follow-up. In contrast, in the MUE group, the IOP values tended to be similar after the first reduction. No relevant complications and no significant differences between the groups in the survival analysis were found. Conclusions: XEN45 provided stable IOP control in both the MCE and MUE group without important complications in the medium term. The IOP increasing in the MCE group, after a prior decrease, led to restored baseline values 1 month after surgery. The homeostatic mechanism that causes the rise in the IOP to baseline values and its relationship with failure cases remains to be clarified.
Collapse
Affiliation(s)
- Gemma Julio
- Centro de Oftalmología Barraquer, 08021 Barcelona, Spain; (G.J.); (R.L.); (M.M.); (A.S.); (M.I.C.)
- Institut Universitari Barraquer, Universitat Autònoma de Catalunya, 08021 Barcelona, Spain
| | - Raquel Larena
- Centro de Oftalmología Barraquer, 08021 Barcelona, Spain; (G.J.); (R.L.); (M.M.); (A.S.); (M.I.C.)
- Institut Universitari Barraquer, Universitat Autònoma de Catalunya, 08021 Barcelona, Spain
| | - Marta Mármol
- Centro de Oftalmología Barraquer, 08021 Barcelona, Spain; (G.J.); (R.L.); (M.M.); (A.S.); (M.I.C.)
- Institut Universitari Barraquer, Universitat Autònoma de Catalunya, 08021 Barcelona, Spain
| | - Anna Soldevila
- Centro de Oftalmología Barraquer, 08021 Barcelona, Spain; (G.J.); (R.L.); (M.M.); (A.S.); (M.I.C.)
- Institut Universitari Barraquer, Universitat Autònoma de Catalunya, 08021 Barcelona, Spain
| | - María Isabel Canut
- Centro de Oftalmología Barraquer, 08021 Barcelona, Spain; (G.J.); (R.L.); (M.M.); (A.S.); (M.I.C.)
- Institut Universitari Barraquer, Universitat Autònoma de Catalunya, 08021 Barcelona, Spain
- Clínica Oftalvist, 08017 Barcelona, Spain
| | - Josip Pavan
- Department of Ophthalmology, Dubrava University Hospital, 10000 Zagreb, Croatia;
| | - Rafael I. Barraquer
- Centro de Oftalmología Barraquer, 08021 Barcelona, Spain; (G.J.); (R.L.); (M.M.); (A.S.); (M.I.C.)
- Institut Universitari Barraquer, Universitat Autònoma de Catalunya, 08021 Barcelona, Spain
- School of Medicine, Universitat Internacional de Catalunya, 08193 Barcelona, Spain
| |
Collapse
|
5
|
Sabogal E, Ingram Z, Odishelidze N, El Helwe H, Falah HK, Trzcinski J, Hall N, Solá-Del Valle D. Comparing Outcomes of Trabeculectomy with Mitomycin C to 45 μm Gelatin Stent Placed Ab Externo with Open Conjunctiva. Ophthalmol Glaucoma 2024; 7:232-241. [PMID: 38056708 DOI: 10.1016/j.ogla.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/23/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE To compare trabeculectomy with mitomycin C (trab-MMC) and XEN45 Gel Stent placed ab externo with open conjunctiva (XGS AEO) with or without cataract surgery in patients with glaucoma. DESIGN Nonrandomized, retrospective, comparative study. SUBJECTS A total of 204 eyes from 204 glaucoma patients who received XGS AEO or underwent trab-MMC with or without cataract surgery between July 2018 and August 2021 at Massachusetts Eye and Ear. METHODS Visits from 204 patient charts were reviewed after either trab-MMC or XGS AEO from 2018 to 2021 from a level 3 triage center. MAIN OUTCOME MEASURES Intraocular pressure (IOP), medication burden, Kaplan-Meier success rates, 5-fluorouracil impact, and complications. RESULTS One hundred fifty-seven patients underwent trab-MMC and 47 underwent XGS AEO. Groups had similar baseline intraocular pressure (IOP) and medications (meds). Intraocular pressure and meds decreased similarly at 1.5 years (11.2 mmHg vs. 7.4 mmHg, P = 0.62; 2.9 vs. 2.8 meds, P = 0.92, respectively for trab-MMC and XGS AEO). Success was defined as IOP reduction ≥ 20% with 5 mmHg ≤ IOP ≤ 18 mmHg for 2 consecutive visits. Complete success (CS) did not allow meds; qualified success (QS) allowed for ≤ baseline meds. When IOP fluctuations in the first 60 days were not counted as failures, CS was 43% for trab-MMC, about 8.5% higher than for XGS AEO (P < 0.01). Qualified success was similar between the groups (65%-67%). Procedure time was shorter for XGS AEO than trab-MMC (44 vs. 63 minutes, P < 0.01). CONCLUSIONS XEN45 Gel Stent AEO may provide similar benefits to trab-MMC, especially for patients who tolerate some meds, with shorter procedure times. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Ernesto Sabogal
- Department of Ophthalmology, Massachusetts Eye and Ear, Glaucoma Service, Boston, Massachusetts
| | - Zoë Ingram
- Department of Ophthalmology, Massachusetts Eye and Ear, Glaucoma Service, Boston, Massachusetts
| | - Nino Odishelidze
- Department of Ophthalmology, Massachusetts Eye and Ear, Glaucoma Service, Boston, Massachusetts
| | - Hani El Helwe
- Department of Ophthalmology, Massachusetts Eye and Ear, Glaucoma Service, Boston, Massachusetts
| | - Henisk K Falah
- Department of Ophthalmology, Massachusetts Eye and Ear, Glaucoma Service, Boston, Massachusetts
| | - Jonathan Trzcinski
- Department of Ophthalmology, Massachusetts Eye and Ear, Glaucoma Service, Boston, Massachusetts
| | - Nathan Hall
- Department of Ophthalmology, Massachusetts Eye and Ear, Glaucoma Service, Boston, Massachusetts
| | - David Solá-Del Valle
- Department of Ophthalmology, Massachusetts Eye and Ear, Glaucoma Service, Boston, Massachusetts.
| |
Collapse
|
6
|
Zaifar A, Pratomo TG, Suryono AN. Comparison between MIGS with trabeculectomy in the management of open-angle glaucoma with cataract: A systematic review. Indian J Ophthalmol 2024; 72:S345-S353. [PMID: 38648451 PMCID: PMC467019 DOI: 10.4103/ijo.ijo_1322_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/28/2023] [Accepted: 12/08/2023] [Indexed: 04/25/2024] Open
Abstract
Age is an important risk factor for both glaucoma and cataract. As global life expectancy continues to rise, the prevalence of concomitant open-angle glaucoma (OAG) and cataracts is increasing. Currently, there is a lack of definitive consensus on the optimal management approach for such individuals. Conventionally, trabeculectomy (Trab) in combination with phacoemulsification is the preferred method. Recent developments in microinvasive glaucoma surgery (MIGS), which offer similar results with fewer complications, provide a new possible approach to this condition. This study aimed to assess the current knowledge of combination surgery in patients with cataract and OAG to provide a comprehensive understanding and help its implementation in clinical settings. A comprehensive systematic search was conducted in May 2021 on five databases (MEDLINE, Embase, SCOPUS, Proquest, EBSCO, and Cochrane Library). The results were filtered for English and human studies but not publication year. All studies published up to May 2021 were reviewed. Newcastle-Ottawa Scale and PEDro scale were used to screen studies for risk of bias where appropriate. Four studies satisfied the inclusion criteria and were subsequently added in this review. Study designs consisted of one RCT and three descriptive studies. Appropriate assessment tools were used; these studies demonstrated moderate to good quality. Postoperative mean IOP, IOP reduction, and qualified success rates were comparable in the Phaco-MIGS (Phaco-endoscopic cyclophotocoagulation (ECP), Phaco-ab interno trabeculectomy (AIT)) and Phaco-Trab group. Severe complication was reported only in the latter. Phaco-MIGS (in particular, trabectome) shows excellent promise as an option for individuals with OAG and concomitant cataract; further research through RCT is required to validate these findings.
Collapse
Affiliation(s)
- Abritho Zaifar
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Tiara Grevillea Pratomo
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Astrianda Nadya Suryono
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| |
Collapse
|
7
|
Evers C, Anton A, Böhringer D, Kallee S, Keye P, Neß T, Philippin H, Reinhard T, Lübke J. XEN ®-45 implantation for refractory uveitic glaucoma. Graefes Arch Clin Exp Ophthalmol 2024; 262:937-948. [PMID: 37855957 PMCID: PMC10907455 DOI: 10.1007/s00417-023-06254-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 08/22/2023] [Accepted: 09/08/2023] [Indexed: 10/20/2023] Open
Abstract
PURPOSE To evaluate the efficacy of XEN®-45 gel stent ab interno implantation for medically uncontrolled uveitic glaucoma. METHODS Retrospective analysis of 25 eyes receiving XEN® gel stent for medically uncontrolled uveitic glaucoma from February 2019 to February 2023 with recording of intraocular pressure (IOP) values, ocular hypotensive medication, requirement for revision or secondary surgery and complications. Prerequisites for XEN® implantation were a clear cornea, an open iridocorneal angle and an unscarred, mobile conjunctiva at the implantation site. Minimum follow-up required for inclusion was 3 months. The primary outcome measure was IOP compared to baseline. Complete and qualified success were defined as final IOP of ≤ 18 mmHg without or with topical antiglaucomatous treatment, respectively. Failure was defined as IOP > 18 mmHg on two consecutive visits, IOP reduction < 20%, persisting complications from hypotony and open conjunctival bleb revision. Further glaucoma surgical intervention was defined as complete failure. RESULTS Mean preoperative IOP was 35.3 ± 10.9 mmHg on 2.9 ± 0.9 topical antiglaucomatous agents. 19 of 25 patients (76%) received additional oral acetazolamide. 19 eyes were pseudophakic, 5 eyes phakic and 1 aphakic. Early postoperatively, mean IOP reduced to 7.7 ± 3.0 mmHg (75.8% reduction). At final follow-up (mean 17.7 months) mean IOP was 12.0 ± 3.8 mmHg (62.5% reduction) on 0.2 ± 0.6 medications. Six eyes (24%) required bleb revision at mean 28 weeks and therefore were categorized as failure. One eye failed despite bleb revision and restart of topical ocular hypotensive medication. Three other eyes (12%) had IOP spikes with uveitis flare-ups. Transient hypotony complications occurred in 32%. At final follow-up, 18 eyes (72%) achieved complete success and one eye (4%) qualified success. CONCLUSION The XEN® gel stent effectively reduced IOP in uncontrolled uveitic glaucoma, with 72% complete success. Bleb revision was required in 24%. IOP spikes occurred in 12% despite functioning blebs. Further follow-up is needed to determine long-term outcomes.
Collapse
Affiliation(s)
- Charlotte Evers
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstraße 5, 79106, Freiburg, Germany.
| | | | - Daniel Böhringer
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstraße 5, 79106, Freiburg, Germany
| | - Sara Kallee
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstraße 5, 79106, Freiburg, Germany
| | - Philip Keye
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstraße 5, 79106, Freiburg, Germany
| | - Thomas Neß
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstraße 5, 79106, Freiburg, Germany
| | - Heiko Philippin
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstraße 5, 79106, Freiburg, Germany
| | - Thomas Reinhard
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstraße 5, 79106, Freiburg, Germany
| | - Jan Lübke
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstraße 5, 79106, Freiburg, Germany
| |
Collapse
|
8
|
Oddone F, Roberti G, Giammaria S, Posarelli C, Ghirelli G, Mastropasqua L, Agnifili L, Micelli Ferrari T, Pace V, Nucci P, Sacchi M, Monsellato G, Altafini R, Scuderi G, Perdicchi A, Uva M, Carnevale C, Covello G, Maglionico MN, Fea A, Figus M. Effectiveness and safety of XEN45 implant over 12 months of follow-up: data from the XEN-Glaucoma Treatment Registry. Eye (Lond) 2024; 38:103-111. [PMID: 37414935 PMCID: PMC10764778 DOI: 10.1038/s41433-023-02642-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 05/29/2023] [Accepted: 06/15/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVES To evaluate the 1-year effectiveness and safety of the XEN45, either alone or in combination with phacoemulsification, in glaucoma patients. METHODS This multicentre, prospective, observational study included consecutive eyes of glaucoma patients from the Italian XEN-Glaucoma Treatment Registry (XEN-GTR) who underwent XEN45 alone or in combination with phacoemulsification, with at least 1 year of follow-up. Surgical success was defined as intraocular pressure (IOP) < 18 mmHg and ≥20% reduction from preoperative IOP, over 1 year of follow-up. RESULTS Two hundred thirty-nine eyes (239 patients) were analyzed, 144 (60.2%) eyes in the XEN-solo and 95 (39.8%) eyes in the XEN+Phaco groups. One hundred-sixty-eight (70.3%) eyes achieved overall success, without statistically significant differences between study groups (p = 0.07). Preoperative IOP dropped from a median (IQR) of 23.0 (20.0-26.0) mmHg to 14.0 (12.0-16.0) mmHg at month 12 (p < 0.001), with overall 39.9 ± 18.3% IOP reduction. The mean number of preoperative ocular hypotensive medications (OHM) was significantly reduced from 2.7 ± 0.9 to 0.5 ± 0.9 at month 12 (p < 0.001). Preoperative IOP < 15 mmHg (HR: 6.63; 95%CI: 2.61-16.84, p < 0.001) and temporal position of the surgeon (HR: 4.25; 95%CI: 2.62-6.88, p < 0.001) were significantly associated with surgery failure. One hundred-forty-six (61.1%) eyes had no intraoperative complications, whereas 91 (38.1%) and 56 (23.4%) eyes experienced at least one complication, respectively early (< month 1) and late (≥ month 1), all self-limiting or successfully treated without sequelae. Needling occurred in 55 (23.0%) eyes at least once during follow-up. CONCLUSION Over 1-year follow-up, XEN45 alone or in combination with phacoemulsification, had comparable success rates and effectively and safely lowered IOP and the need for OHM.
Collapse
Affiliation(s)
| | | | | | - Chiara Posarelli
- Department of Surgical, Medical, Molecular Pathology and of Critical Care Medicine, University of Pisa, Pisa, Italy
| | | | - Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | | | - Vincenzo Pace
- Regional General Hospital F. Miulli of Acquaviva delle Fonti, Bari, Italy
| | - Paolo Nucci
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
| | - Matteo Sacchi
- Eye Clinic, San Giuseppe Hospital - IRCCS Multimedica, Milan, Italy
| | | | | | - Gianluca Scuderi
- Ophthalmology Unit, St. Andrea Hospital, NESMOS Department, University of Rome "Sapienza", Rome, Italy
| | - Andrea Perdicchi
- Ophthalmology Unit, St. Andrea Hospital, NESMOS Department, University of Rome "Sapienza", Rome, Italy
| | - Maurizio Uva
- University Hospital "Policlinico Vittorio Emanuele", Catania, Italy
| | | | - Giuseppe Covello
- Department of Surgical, Medical, Molecular Pathology and of Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Maria Novella Maglionico
- Department of Surgical, Medical, Molecular Pathology and of Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Antonio Fea
- Struttura Complessa Oculistica, Città Della Salute e Della Scienza di Torino, Dipartimento di Scienze Chirurgiche-Università Degli Studi di Torino, 10126, Torino, Italy
| | - Michele Figus
- Department of Surgical, Medical, Molecular Pathology and of Critical Care Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
9
|
Savastano A, Carlà MM, Gambini G, Giannuzzi F, Boselli F, Rizzo S. Inferior implant of XEN63 Gel stent in a refractory open-angle glaucoma due to silicone oil tamponade: A case report. Eur J Ophthalmol 2024; 34:NP27-NP31. [PMID: 37192674 DOI: 10.1177/11206721231172231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND To discuss the efficacy of an inferior implant of XEN 63 gel stent in a patient with refractory glaucoma after trabeculectomy failure and vitreoretinal surgery with silicone oil tamponade. CASE DESCRIPTION We report the case of a 73-year-old man with a history of refractory open glaucoma with trabeculectomy failure. He experienced recurrent retinal detachments with silicone oil tamponade, with uncontrolled intra-ocular pressure (IOP) after silicone oil removal. Due to the presence of oil emulsion in the anterior chamber, the chosen location for XEN 63 implantation was the infero-temporal quadrant. Mild hyphema and vitreous hemorrhage were seen post-operatively, but were self-limiting. At week 1, the intraocular pressure was 8 mmHg with a well-formed bleb seen in anterior segment optical coherence tomography (AS-OCT). At 6 month follow up, the patient maintained a IOP of 12 mmHg without topical hypotensive drugs. Slit lamp examination revealed a widespread, developed bleb with no signs of inflammation. CONCLUSION In this case of refractory glaucoma in a vitrectomized eye with previous oil tamponade, the inferior placement of the XEN 63 gel stent delivered an adequate intraocular pressure even at 6-months follow up, with a diffuse functional infero-nasal bleb seen with AS-OCT.
Collapse
Affiliation(s)
- Alfonso Savastano
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome, Italy
- Ophthalmology Unit, Catholic University "Sacro Cuore", Rome, Italy
| | - Matteo Mario Carlà
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome, Italy
- Ophthalmology Unit, Catholic University "Sacro Cuore", Rome, Italy
| | - Gloria Gambini
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome, Italy
- Ophthalmology Unit, Catholic University "Sacro Cuore", Rome, Italy
| | - Federico Giannuzzi
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome, Italy
- Ophthalmology Unit, Catholic University "Sacro Cuore", Rome, Italy
| | - Francesco Boselli
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome, Italy
- Ophthalmology Unit, Catholic University "Sacro Cuore", Rome, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", Rome, Italy
- Ophthalmology Unit, Catholic University "Sacro Cuore", Rome, Italy
| |
Collapse
|
10
|
Pirani V, Virgili F, Ramovecchi V. Short-Term Outcomes of XEN45 Standalone versus Combined with Phacoemulsification in Open-Angle Glaucoma Patients: A Retrospective Study. J Clin Med 2023; 13:157. [PMID: 38202164 PMCID: PMC10780016 DOI: 10.3390/jcm13010157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024] Open
Abstract
The XEN45 is a minimally invasive glaucoma surgery device commonly used in clinical practice. This retrospective study included consecutive patients with open-angle glaucoma who underwent a XEN45 implant with mitomycin C, either alone or in combination with phacoemulsification, between June 2015 and March 2021. The primary end point was the mean change in intraocular pressure (IOP) from the baseline to month 6. A total of 677 eyes, 395 (58.3%) in the XEN alone group and 282 (41.7%) in the XEN+Phaco group, were included in this study. The preoperative IOP was significantly lowered from 28.7 ± 8.6 mmHg and 25.4 ± 6.9 mmHg to 13.5 ± 5.0 mmHg and 13.5 ± 4.1 mmHg at month 6 in the XEN solo and XEN+Phaco groups, respectively, with p < 0.0001 each. The mean (95% confidence interval) number of ocular hypotensive medications was significantly reduced from 3.3 (3.2-3.4) to 0.2 (0.1-0.2) and from 3.1 (2.9-3.2) to 0.2 (0.1-0.2) in the XEN solo and XEN+Phaco groups, respectively, with p < 0.0001 each. Needling was performed in 228 (33.7%) eyes. Conclusions: the XEN implant significantly reduces both IOP and the number of ocular hypotensive medications. IOP lowering was higher in the XEN solo group than in the XEN+Phaco one, although such a difference was only evident during the first month after surgery.
Collapse
Affiliation(s)
| | | | - Vincenzo Ramovecchi
- ASUR—Area Vasta 3, Ospedale di San Severino Marche, Via Del Glorioso, 8, 62027 San Severino Marche, Italy; (V.P.); (F.V.)
| |
Collapse
|
11
|
Schlenker MB, Armstrong JJ, De Francesco T, Ahmed IIK. All Consecutive Ab Externo SIBS Microshunt Implantations With Mitomycin C: One-Year Outcomes and Risk Factors for Failure. Am J Ophthalmol 2023; 255:125-140. [PMID: 37352909 DOI: 10.1016/j.ajo.2023.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/28/2023] [Accepted: 06/07/2023] [Indexed: 06/25/2023]
Abstract
PURPOSE To present the effectiveness, risk factors for surgical failure, and adverse events over 12 months in a consecutive diverse cohort of glaucoma patients who underwent solo or combined ab externo SIBS microshunt with mitomycin C (MMC) with or without previous subconjunctival surgery. DESIGN Retrospective, consecutive, interventional case series. METHODS Consecutive glaucomatous eyes on maximally tolerated medical therapy received ab externo SIBS microshunt with MMC implantation as a solo or combined procedure with phacoemulsification from July 2015 to January 2020. The primary outcome was the proportion of eyes at 12-months with the following: (1) no 2 consecutive intraocular pressures (IOPs) >17 mm Hg or clinical hypotony, without (complete success) or with (qualified success) glaucoma medications; and (2) ≥20% reduction from baseline IOP. Secondary outcomes included upper IOP thresholds of 14 and 21 mm Hg with and without a 20% IOP reduction from baseline, median IOP, medications, risk factors for failure, postoperative interventions, complications, and reoperations. RESULTS A total of 436 eyes underwent surgery; 86 (20%) combined with phacoemulsification, 127 (29%) in eyes with refractory glaucoma, and 234 (51%) stand-alone procedures in non-refractory eyes. Complete success (6-17 mm Hg with no medications) was achieved in 64.0% of combined eyes, 58.1% of refractory eyes, and 74.8% of stand-alone non-refractory eyes; and qualified success rates (6-17 mm Hg with medications) were 90.7%, 84.7%, and 92.4% of eyes, respectively. At 12 months, 67% of eyes were medication free. Significant risk factors for failure included combined procedures in refractory eyes (hazard ratio [HR] = 3.2; 95% CI = 1.4-7.4), receiving <0.4 mg/mL of MMC (HR = 2.2; 95% CI = 1.6-3.1), refractory eyes (HR = 1.7; 95% CI = 1.2-2.5), combined procedures (HR = 1.6; 95% CI = 1.0-2.5), and each additional baseline medication class (HR = 1.3; 95% CI = 1.1-1.5). Postoperative complications occurred in 31% of eyes, and more often in those receiving ≥0.4 mg/mL MMC (odds ratio [OR] = 2.2, 95% CI 1.2-3.8). Needling occurred in 12% of eyes, with significantly higher frequency in refractory eyes (23%) and combined procedures (13%) compared to stand-alone (7%; P < .001). Revisions and reoperations occurred in 4% and 1.4% of eyes, respectively. CONCLUSIONS The 1-year follow-up data from this large and diverse cohort support promising rates of qualified and complete surgical success with decreased medication burden and few postoperative complications and interventions. Combined phacoemulsification, refractory glaucoma, and receiving <0.4mg/mL MMC were associated with reduced surgical success rates.
Collapse
Affiliation(s)
- Matthew B Schlenker
- From the Department of Ophthalmology and Vision Sciences (M.B.S., J.J.A.,I.I.K.A.), University of Toronto, Toronto, Ontario, Canada; Prism Eye Institute (M.B.S., J.J.A., I.I.K.A.), Mississauga, Ontario, Canada; John A. Moran Eye Center (M.B.S., T.D.F., I.I.K.A.), University of Utah, Salt Lake City, Utah, USA.
| | - James J Armstrong
- From the Department of Ophthalmology and Vision Sciences (M.B.S., J.J.A.,I.I.K.A.), University of Toronto, Toronto, Ontario, Canada; Prism Eye Institute (M.B.S., J.J.A., I.I.K.A.), Mississauga, Ontario, Canada
| | - Ticiana De Francesco
- John A. Moran Eye Center (M.B.S., T.D.F., I.I.K.A.), University of Utah, Salt Lake City, Utah, USA; Hospital de Olhos Leiria de Andrade (T.D.F.), Fortaleza, Ceará, Brazil
| | - Iqbal Ike K Ahmed
- From the Department of Ophthalmology and Vision Sciences (M.B.S., J.J.A.,I.I.K.A.), University of Toronto, Toronto, Ontario, Canada; Prism Eye Institute (M.B.S., J.J.A., I.I.K.A.), Mississauga, Ontario, Canada; John A. Moran Eye Center (M.B.S., T.D.F., I.I.K.A.), University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
12
|
Torbey J, Paillard A, Rao HL, Gillman K, Bravetti GE, Mermoud A, Mansouri K. XEN 45 Gel Stent Implantation in Open Angle Glaucoma: 5-Year Results of a Prospective Study. J Glaucoma 2023; 32:909-917. [PMID: 37725786 DOI: 10.1097/ijg.0000000000002302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/16/2023] [Indexed: 09/21/2023]
Abstract
PRCIS XEN 45 Gel Stent is safe and effective for 3 years. The study results provide useful insight into the outcome of XEN 45 Gel Stent surgery over 5 years in daily clinical practice. PURPOSE To evaluate 5-year outcomes of XEN 45 gel stent implantation (XEN) in patients with open angle glaucoma. METHODS This is a prospective, single-center, interventional study. XEN implantation either alone (XEN) or combined with phacoemulsification (Phaco + XEN) was performed on 170 consecutive eyes (126 patients) with uncontrolled intraocular pressure (IOP) or disease progression despite medical treatment. "Complete" surgical success at 60 months was defined as unmedicated IOP ≤15 mm Hg and a relative IOP reduction ≥20% from medicated baseline, while "qualified" success allowed fewer ocular hypotensive medications than at baseline. Other definitions of success with various IOP targets were also analyzed. Secondary outcomes included mean IOP and IOP-lowering medication changes and rates of reoperations. RESULTS Mean age was 78.1±9.2 years, and 70.3% were female. Mean medicated IOP decreased from 19.8±7.7 mm Hg [19.6±7.1 (XEN) vs. 19.8±7.0 mm Hg (Phaco+XEN)] at baseline to 12.6±3.1 mm Hg [12.5± 3.1 (XEN) vs. 12.6±3.1 (Phaco+XEN)] at 5 years (-37.0%; P < 0.001). Medications decreased from 2.0±1.3 [2.0±1.3 (XEN) vs. 2.0±1.3 (Phaco+XEN)] to 0.8±1.1 [0.8±1.1 (XEN) vs. 0.8±1.1 (Phaco + XEN)] (-60%; P <0.001). Needling was performed in 84 eyes (49%), and 19.4% underwent a secondary surgical intervention. Complete success at 3 years was a strong predictor of success at 5 years (odds ratio: 3.06, P <0.01), while needling was associated with higher rates of failure (odds ratio: 3.6, P <0.01). CONCLUSIONS At 5 years, XEN gel stent implantation was a safe procedure and achieved clinically meaningful IOP and medication reduction. Success at 3 years is a predictor of success at 5 years. Needling correlates with higher failure rates.
Collapse
Affiliation(s)
- Julien Torbey
- Glaucoma Research Centre, Montchoisi Clinic, Swiss Visio Network, Lausanne, Switzerland
| | - Archibald Paillard
- Glaucoma Research Centre, Montchoisi Clinic, Swiss Visio Network, Lausanne, Switzerland
| | | | - Kevin Gillman
- Glaucoma Research Centre, Montchoisi Clinic, Swiss Visio Network, Lausanne, Switzerland
| | - Giorgio E Bravetti
- Glaucoma Research Centre, Montchoisi Clinic, Swiss Visio Network, Lausanne, Switzerland
| | - André Mermoud
- Glaucoma Research Centre, Montchoisi Clinic, Swiss Visio Network, Lausanne, Switzerland
| | - Kaweh Mansouri
- Glaucoma Research Centre, Montchoisi Clinic, Swiss Visio Network, Lausanne, Switzerland
- Department of Ophthalmology, University of Colorado School of Medicine, Denver, CO
| |
Collapse
|
13
|
Lin BR, Al-Khersan H, Bitrian E, Flynn HW. Endophthalmitis Associated With XEN Stent Implantation. Am J Ophthalmol 2023; 253:37-43. [PMID: 37059319 PMCID: PMC10524262 DOI: 10.1016/j.ajo.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE The aim of this study is to report the clinical characteristics, causative organisms, and treatment outcomes in patients presenting with endophthalmitis related to XEN stent implants. DESIGN Retrospective, noncomparative consecutive case series. METHODS Clinical and microbiologic review was performed for 8 patients presenting to the Bascom Palmer Eye Institute Emergency Room between 2021 and 2022 with XEN stent-related endophthalmitis. Data collected included clinical characteristics of patients at presentation, organisms identified in ocular cultures, treatments received, and visual acuity at last follow-up. RESULTS The current study included 8 eyes from 8 patients. All cases of endophthalmitis occurred >30 days after implantation of the XEN stent. At the time of presentation, there were external exposures of the XEN stent in 4 of 8 patients. Five of the 8 patients had positive intraocular cultures, all of which were variants of staphylococcus and streptococcus species. Management included intravitreal antibiotics in all patients, explantation of the XEN stent in 5 patients (62.5%), and pars plana vitrectomy in 6 patients (75%). At last follow-up, 6 of the 8 patients (75%) had a visual acuity of hand motion or worse. CONCLUSIONS Endophthalmitis in the setting of XEN stents results in poor visual outcomes. The most common causative organisms are staphylococcus or streptococcus species. At time of diagnosis, prompt treatment with broad-spectrum intravitreal antibiotics is recommended. Consideration can be made to explant the XEN stent and perform early pars plana vitrectomy.
Collapse
Affiliation(s)
- Benjamin R Lin
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Hasenin Al-Khersan
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Elena Bitrian
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Harry W Flynn
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA..
| |
Collapse
|
14
|
Traverso CE, Carassa RG, Fea AM, Figus M, Astarita C, Piergentili B, Vera V, Gandolfi S. Effectiveness and Safety of Xen Gel Stent in Glaucoma Surgery: A Systematic Review of the Literature. J Clin Med 2023; 12:5339. [PMID: 37629380 PMCID: PMC10455777 DOI: 10.3390/jcm12165339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Although topical medical therapy and selective-laser-trabeculoplasty represent the treatments of choice to reduce intraocular pressure, many patients do not achieve adequate glaucoma control; therefore, they require further options and eventually surgery. Trabeculectomy is still considered the gold standard, but the surgical management of glaucoma has undergone continuous advances in recent years, XEN-gel-stent has been introduced as a safer and less traumatic means of lowering intraocular pressure (IOP) in patients with open-angle glaucoma (OAG). This study aimed to review the effectiveness and safety of clinical data on XEN-stent in OAG patients with a Synthesis-Without-Meta-analysis (SWiM) methodology. A total of 339 studies were identified following a literature search adhering to PRISMA guidelines and, after evaluation, 96 studies are discussed. XEN63 and XEN45 device data were collected both short and long term. In addition, this document has evaluated different aspects related to the XEN implant, including: its role compared to trabeculectomy; the impact of mitomycin-C dose on clinical outcomes; postoperative management of the device; and the identification of potential factors that might predict its clinical outcomes. Finally, current challenges and future perspectives of XEN stent, such as its use in fragile or high myopia patients, were discussed.
Collapse
Affiliation(s)
- Carlo Enrico Traverso
- Eye Clinic, IRCCS San Martino Polyclinic Hospital, 16132 Genoa, Italy;
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, 16126 Genoa, Italy
| | | | - Antonio Maria Fea
- Department of Surgical Sciences, University of Turin, 10122 Turin, Italy;
| | - Michele Figus
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Carlo Astarita
- AbbVie S.r.l., 04011 Campoverde, LT, Italy; (C.A.); (B.P.)
| | | | | | - Stefano Gandolfi
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy;
| |
Collapse
|
15
|
Sheybani A, Vera V, Grover DS, Vold SD, Cotter F, Bedrood S, Sawhney G, Piette SD, Simonyi S, Gu X, Balaram M, Gallardo MJ. Gel Stent Versus Trabeculectomy: The Randomized, Multicenter, Gold-Standard Pathway Study (GPS) of Effectiveness and Safety at 12 Months. Am J Ophthalmol 2023; 252:306-325. [PMID: 36972738 DOI: 10.1016/j.ajo.2023.03.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/16/2023] [Accepted: 03/18/2023] [Indexed: 03/28/2023]
Abstract
PURPOSE To compare effectiveness and safety of the gel stent to trabeculectomy in open-angle glaucoma (OAG). DESIGN Prospective, randomized, multicenter, noninferiority study. METHODS Patients with OAG and intraocular pressure (IOP) 15 to 44 mm Hg on topical IOP-lowering medication were randomized 2:1 to gel stent implantation or trabeculectomy. Primary end point (surgical success): percentage of patients at month 12 achieving ≥20% IOP reduction from baseline without medication increase, clinical hypotony, vision loss to counting fingers, or secondary surgical intervention (SSI) in a noninferiority test with 24% margins. Secondary end points (month 12) included mean IOP and medication count, postoperative intervention rate, visual recovery, and patient-reported outcomes (PROs). Safety end points included adverse events (AEs). RESULTS At month 12, the gel stent was statistically noninferior to trabeculectomy (between-treatment difference [Δ], -6.1%; 95% CI, -22.9%, 10.8%); 62.1% and 68.2% achieved the primary end point, respectively (P=.487); mean IOP and medication count reductions from baseline were significant (P<.001); and the IOP change-related Δ (2.8 mm Hg) favored trabeculectomy (P=.024). The gel stent resulted in fewer eyes requiring in-office postoperative interventions (P=.024 after excluding laser suture lysis), faster visual recovery (P≤.048), and greater 6-month improvements in visual function problems (ie, PROs; P≤.022). The most common AEs were reduced visual acuity at any time (gel stent, 38.9%; trabeculectomy, 54.5%) and hypotony (IOP <6 mm Hg at any time) (gel stent, 23.2%; trabeculectomy, 50.0%). CONCLUSIONS At month 12, the gel stent was statistically noninferior to trabeculectomy, per the percentage of patients achieving ≥20% IOP reduction from baseline without medication increase, clinical hypotony, vision loss to counting fingers, or SSI. Trabeculectomy achieved a statistically lower mean IOP, numerically lower failure rate, and numerically lower need for supplemental medications. The gel stent resulted in fewer postoperative interventions, better visual recovery, and fewer AEs.
Collapse
Affiliation(s)
- Arsham Sheybani
- Washington University School of Medicine (A.S.), St Louis, Missouri, USA.
| | - Vanessa Vera
- Allergan, an AbbVie company (V.V.), Irvine, California, USA
| | | | | | - Frank Cotter
- Vistar Eye Center (F.C.), Roanoke, Virginia, USA
| | - Sahar Bedrood
- Acuity Eye Group (S.B.), Arcadia, California, USA; Advanced Vision Care (S.B.), Los Angeles, California, USA
| | | | | | | | - Xuemin Gu
- AbbVie (X.G.), Madison, New Jersey, USA
| | - Mini Balaram
- Nethra Consulting LLC (M.B.), Princeton, New Jersey, USA
| | | |
Collapse
|
16
|
Evers C, Böhringer D, Kallee S, Keye P, Philippin H, Piotrowski T, Reinhard T, Lübke J. XEN ®-63 Compared to XEN ®-45 Gel Stents to Reduce Intraocular Pressure in Glaucoma. J Clin Med 2023; 12:5043. [PMID: 37568443 PMCID: PMC10419806 DOI: 10.3390/jcm12155043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
The XEN® gel stent reduces intraocular pressure (IOP) in glaucoma. XEN®-45 is widely used; the newer XEN®-63 has a larger lumen targeting potentially lower IOP outcomes. We retrospectively compared the first 15 XEN®-63 cases to 15 matched XEN®-45 controls. With a preoperative IOP of 18.1 ± 3.9 mmHg (mean ± SD) and a final IOP of 9.1 ± 2.0 mmHg, XEN®-63 implantation resulted in an IOP reduction of 44.6 ± 16.5%. Similarly, with a preoperative IOP of 18.3 ± 4.5 mmHg and a final IOP of 10.3 ± 2.1 mmHg, XEN®-45 implantation resulted in an IOP reduction of 40.1 ± 17.2%. The median follow-up period was 204 days (range 78-338 days) for the XEN®-63 group and 386 days (range 99-1688 days) for the XEN®-45 group. In total, 5/15 eyes of each group underwent open conjunctival bleb revision within the period of observation. Three eyes of the XEN®-63 group had secondary glaucoma surgery. One eye in the XEN®-63 group and three eyes in the XEN®-45 group required a restart of antiglaucomatous medication. In conclusion, both stents effectively lower IOP and medication. XEN®-63 achieved a slightly lower IOP over a short follow-up. Complication and revision rates were similar.
Collapse
Affiliation(s)
- Charlotte Evers
- Eye Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Daniel Böhringer
- Eye Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Sara Kallee
- Eye Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Philip Keye
- Eye Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Heiko Philippin
- Eye Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- International Centre for Eye Health, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Timothy Piotrowski
- Eye Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Thomas Reinhard
- Eye Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Jan Lübke
- Eye Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| |
Collapse
|
17
|
Luo N, Liu M, Hao M, Xu R, Wang F, Zhang W. Comparison of tube shunt implantation and trabeculectomy for glaucoma: a systematic review and meta-analysis. BMJ Open 2023; 13:e065921. [PMID: 37080625 DOI: 10.1136/bmjopen-2022-065921] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE To compare the efficacy and safety of tube shunt implantation with trabeculectomy in the treatment of patients with glaucoma. METHODS A systematic literature search was performed for studies comparing tube with trabeculectomy in patients with glaucoma (final search date: 27 February 2022). Comparisons between tube and trabeculectomy were grouped by the type of tube (Ahmed, Baerveldt, Ex-PRESS and XEN). The primary endpoints included intraocular pressure (IOP), IOP reduction (IOPR), IOPR percentage (IOPR%), complete success rate (CSR), qualified success rate (QSR) and adverse events (AEs). RESULTS Forty-nine studies were included in this meta-analysis and presented data for 3795 eyes (Ahmed: 670, Baerveldt: 561, Ex-PRESS: 473, XEN: 199, trabeculectomy: 1892). Ahmed and Ex-PRESS were similar to trabeculectomy in terms of IOP outcomes and success rate (Ahmed vs trabeculectomy: IOPR%: mean difference (MD)=1.34 (-5.35, 8.02), p=0.69; Ex-PRESS vs trabeculectomy: IOPR%: MD=0.12 (-3.07, 3.31), p=0.94). The IOP outcomes for Baerveldt were worse than those for trabeculectomy (IOPR%: MD=-7.51 (-10.68, -4.35), p<0.00001), but the QSR was higher. No significant difference was shown for the CSR. XEN was worse than trabeculectomy in terms of IOP outcomes (IOPR%: MD=-7.87 (-13.55, -2.18), p=0.007), while the success rate was similar. Ahmed and Ex-PRESS had a lower incidence of AEs than trabeculectomy. Baerveldt had a lower incidence of bleb leakage/wound leakage, hyphaema and hypotonic maculopathy than trabeculectomy but a higher incidence of concurrent cataracts, diplopia/strabismus and tube erosion. The incidence of AEs was similar for the XEN and trabeculectomy procedures. CONCLUSION Compared with trabeculectomy, both Ahmed and Ex-PRESS appear to be associated with similar ocular hypotensive effects and lower incidences of AEs. However, Baerveldt and XEN cannot achieve sufficient reductions in IOP outcomes similar to those of trabeculectomy. PROSPERO REGISTRATION NUMBER CRD42021257852.
Collapse
Affiliation(s)
- Nachuan Luo
- Department of Thoracic Surgery, The second Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Miaowen Liu
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Meiqi Hao
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Ruoxin Xu
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Fei Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Wenxiong Zhang
- Department of Thoracic Surgery, The second Affiliated Hospital of Nanchang University, Nanchang, China
| |
Collapse
|
18
|
Betzler BK, Lim SY, Lim BA, Yip VCH, Ang BCH. Complications and post-operative interventions in XEN45 gel stent implantation in the treatment of open angle glaucoma-a systematic review and meta-analysis. Eye (Lond) 2023; 37:1047-1060. [PMID: 35347294 PMCID: PMC10101986 DOI: 10.1038/s41433-022-02022-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 01/31/2022] [Accepted: 03/10/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The XEN45 Gel Stent is a subconjunctival filtering device that has demonstrated promising efficacy. This meta-analysis quantitatively evaluates reported complications and interventions after XEN45 implantation in the treatment of open angle glaucoma (OAG). METHODS Pilot, cohort, observational studies, and randomised controlled trials that included at least ten patients undergoing ab interno or externo XEN45 surgery, with or without phacoemulsification were deemed eligible for inclusion. A meta-analysis of proportions with random-effect models was performed using the meta routine in R version 3.2.1. Outcomes included the rate of complications and post-operative interventions. RESULTS One hundred and fifty-two studies were identified on initial literature search and 33 were included in final analysis. Numerical hypotony was the most common post-operative complication, involving 20% of patients (95% CI: 10-31%). Post-operative gross hyphema occurred in 14% (95% CI: 7-22%) and transient intra-ocular pressure (IOP) spikes (>30 mmHg) in 13% (95% CI: 4-27%). Stent exposure occurred in 1% (95% CI: 0-2%). Stent migration occurred in 1% (95% CI: 0-3%). XEN45 revision and/or a second XEN45 implantation was performed in 5% of patients (95% CI: 3-7%). Stent relocation was performed in 3% (95% CI: 1-7%). A second glaucoma procedure was performed in 11% (95% CI: 8-15%). 26% underwent one (95% CI: 17-36%), 13% underwent two (95% CI: 5-24%) while 4% underwent three (95% CI: 2-6%) bleb needling procedures. 35% of patients (95% CI: 29-40%) required at least one needling. The average rate of needling per patient was 0.38 (95% CI: 0.20-0.59). However, there is a lack of high-quality data, with 8 of the 33 studies assessed to have a moderate to high risk of bias. CONCLUSIONS While literature suggests that XEN45 Gel Stent implantation is safe in the treatment of OAG, the overall current level of evidence is low and further studies are needed. More than a third of patients require at least one post-operative bleb needling procedure.
Collapse
Affiliation(s)
- Bjorn Kaijun Betzler
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sheng Yang Lim
- Army Medical Services, Singapore Armed Forces, Singapore, Singapore
| | - Boon Ang Lim
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore, Singapore
| | - Vivien Cherng Hui Yip
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore, Singapore
| | - Bryan Chin Hou Ang
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore, Singapore.
- Department of Ophthalmology, Woodlands Health Campus, National Healthcare Group Eye Institute, Singapore, Singapore.
| |
Collapse
|
19
|
Sacchi M, Fea AM, Monsellato G, Tagliabue E, Villani E, Ranno S, Nucci P. Safety and Efficacy of Ab Interno XEN 45 Gel Stent in Patients with Glaucoma and High Myopia. J Clin Med 2023; 12:jcm12072477. [PMID: 37048569 PMCID: PMC10095138 DOI: 10.3390/jcm12072477] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
This study reports on the safety and efficacy of Xen 45 in patients with glaucoma and high myopia. It was a retrospective study including patients with high myopia (>6D) who underwent Xen implant with 2 years of follow-up. The primary outcome was to report the incidence of hypotony (IOP ≤ 5 mmHg) and hypotony-related complications. Patients with high myopia treated with mitomycin-C-augmented trabeculectomy were included as a control group. We included 14 consecutive patients who underwent Xen implant (seven eyes) and trabeculectomy (seven eyes). The mean myopia was −14.71 ± 5.36 and −15.07 ± 6.11 in the trabeculectomy and Xen groups, respectively (p > 0.05). The success rate and the mean IOP at 1 and 2 years from the intervention were statistically comparable between the two groups. The group undergoing trabeculectomy showed a higher incidence of hypotony (six eyes (85.71%) vs. two eyes (28.57%)) and hypotony maculopathy (three eyes (42.86%) vs. zero eyes (0%)) and required more postoperative procedures. Patients with high myopia were at higher risk of hypotony-related complications after trabeculectomy. The Xen implant can achieve an IOP control comparable to trabeculectomy with a significantly better safety profile and can be considered as an option for the management of patients with high myopia and glaucoma.
Collapse
|
20
|
Kiuchi Y, Inoue T, Shoji N, Nakamura M, Tanito M. The Japan Glaucoma Society guidelines for glaucoma 5th edition. Jpn J Ophthalmol 2023; 67:189-254. [PMID: 36780040 DOI: 10.1007/s10384-022-00970-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/22/2022] [Indexed: 02/14/2023]
Abstract
We are pleased to bring you the 5th edition of the Glaucoma Clinical Practice Guidelines. Clinical practice guidelines are based on evidence (scientific grounds). It is a document that presents the treatment that is the most appropriate for the patient. "Glaucoma Clinical Guidelines" was first published in 2003. This was the first guideline for glaucoma treatment in Japan. The principle of glaucoma treatment is to lower intraocular pressure. Means for lowering intraocular pressure includes drugs, lasers, and surgery; Glaucoma is a disease that should be considered as a complex syndrome rather than a single condition. Therefore, the actual medical treatment is not as simple as one word. This time we set the Clinical Questionnaire with a focus on glaucoma treatment. We hope that you will take advantage of the 5th edition.
Collapse
Affiliation(s)
- Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-31 Kasumi, Minami-ku, Hiroshima, Japan.
| | - Toshihiro Inoue
- Department of Ophthalmology, Faculty of Life Science, Kumamoto University, Kumamoto, Japan
| | - Nobuyuki Shoji
- Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Makoto Nakamura
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan
| |
Collapse
|
21
|
Fea A, Sacchi M, Franco F, Laffi GL, Oddone F, Costa G, Serino F, Giansanti F. Effectiveness and Safety of XEN45 in Eyes With High Myopia and Open Angle Glaucoma. J Glaucoma 2023; 32:178-185. [PMID: 36730214 DOI: 10.1097/ijg.0000000000002151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 11/14/2022] [Indexed: 02/03/2023]
Abstract
PRCIS XEN45 implant was an effective and safe procedure in primary open angle glaucoma (OAG) eyes with high myopia. Although the hypotony incidence rate was relatively high, it resolved with medical therapy and was of short duration. PURPOSE The purpose of this study is to evaluate the effectiveness and safety of the XEN45 stent in eyes with OAG and high myopia. DESIGN Retrospective and multicenter study. METHODS Consecutive OAG patients who underwent a XEN45, either alone or in combination with cataract surgery, and had a refractive error higher than -6 D and an axial length ≥26 mm. The primary endpoint was the mean intraocular pressure (IOP) lowering at the last follow-up visit. RESULTS Thirty-one eyes were included (96.8% with a primary OAG diagnosis). The mean refraction was -13.2±5.6 (range: -6.75 to-23.0) D. In the overall study sample, preoperative mean IOP (95% CI) was significantly lowered from 23.5 (20.5-26.4) mm Hg to 13.0 (12.2-13.8) mm Hg at the last follow-up visit, P <0.0001. At the last follow-up visit, 16 (57.1%) eyes achieved an IOP ≤14 mm Hg, 11 (68.9%) of them without treatment. The number of ocular hypotensive medications was significantly reduced from 3.0±1.1 drugs at preoperatively to 0.6±1.0 drugs at the last follow-up visit, P <0.0001. Median (95% CI) follow-up was 24.0 (12.0-24.0) months. Linear regression analysis showed a significant correlation between the preoperative refraction and the IOP lowering ( r =0.43, P =0.0155). Needling procedure was performed in 11 eyes (39.3%) and hypotony (defined as an IOP <6 mm Hg) was observed in 8 eyes (28.6%) during the first postoperative day and remained for a week. CONCLUSION Although the Xen implant effectively lowered IOP in highly myopic eyes with glaucoma, the incidence of hypotony was high, and in most cases, resolved within the first month with medical management and monitoring.
Collapse
Affiliation(s)
- Antonio Fea
- Complex Ophthalmology Structure, City of Health and Science of Turin, Department of Surgical Sciences - University of Turin, Turin
| | - Matteo Sacchi
- Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan
| | - Fabrizio Franco
- Ophthalmology Department, SOD Ophthalmology, AOU Careggi Florence, Florence, Italy
| | | | | | - Giacomo Costa
- Ophthalmology Department, SOD Ophthalmology, AOU Careggi Florence, Florence, Italy
| | - Federica Serino
- Ophthalmology Department, SOD Ophthalmology, AOU Careggi Florence, Florence, Italy
| | - Fabrizio Giansanti
- Ophthalmology Department, SOD Ophthalmology, AOU Careggi Florence, Florence, Italy
| |
Collapse
|
22
|
Panarelli JF, Vera V, Sheybani A, Radcliffe N, Fiscella R, Francis BA, Smith OU, Noecker RJ. Intraocular Pressure and Medication Changes Associated with Xen Gel Stent: A Systematic Review of the Literature. Clin Ophthalmol 2023; 17:25-46. [PMID: 36660309 PMCID: PMC9845068 DOI: 10.2147/opth.s390955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
Abstract
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 decision-making, 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.
Collapse
Affiliation(s)
- Joseph F Panarelli
- Department of Ophthalmology, New York University, New York, NY, USA,Correspondence: Joseph F Panarelli, Department of Ophthalmology, New York University, 222 E 41st St, 3rd Floor, New York, NY, 10017, USA, Email
| | | | - Arsham Sheybani
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Nathan Radcliffe
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York, NY, USA
| | | | - Brian A Francis
- Department of Ophthalmology, Doheny Eye Institute, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Robert J Noecker
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA,Ophthalmic Consultants of Connecticut, Fairfield, CT, USA
| |
Collapse
|
23
|
Marcos-Parra MT, Salinas-López JA, Mateos-Marcos C, Moreno-Castro L, Mendoza-Moreira AL, Pérez-Santonja JJ. Long-Term Effectiveness of XEN 45 Gel-Stent in Open-Angle Glaucoma Patients. Clin Ophthalmol 2023; 17:1223-1232. [PMID: 37131537 PMCID: PMC10149073 DOI: 10.2147/opth.s405821] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/14/2023] [Indexed: 05/04/2023] Open
Abstract
Purpose To assess the effectiveness of XEN45, either alone or in combination with phacoemulsification, in open-angle glaucoma (OAG) patients in clinical practice. Methods Retrospective and single-center study conducted on OAG patients who underwent XEN45 implant, either alone or in combination with cataract surgery. We compared the clinical outcomes of the eyes of thosewho underwent XEN-solo versus those who underwent XEN+Phacoemulsification. The primary endpoint was the mean change in intraocular pressure (IOP) from baseline to the last follow-up visit. Results A total of 154 eyes, 37 (24.0%) eyes that underwent XEN-solo and 117 (76.0%) eyes that underwent XEN+Phacoemulsification, were included. The mean preoperative IOP was significantly lowered from 19.1±5.0 mmHg to 14.9±3.8 mmHg at month-36, p<0.0001. Preoperative IOP was significantly lowered from 21.2±6.2 mmHg and 18.4±4.3 mmHg to 14.3±4.0 mm Hg and 15.2±3.7 mmHg at month-36 in the XEN-solo and XEN+Phacoemulsification groups, p<0.0004 and p=0.0009; with no significant differences between them. In the overall study population, the mean number of antiglaucoma medications was significantly reduced from 2.1±0.8 to 0.2±0.6, p<0.0001. There were no significant differences in the proportion of eyes with a final IOP ≤14 mmHg and ≤16 mmHg between XEN-solo and XEN+Phaco groups (p=0.8406 and 0.04970, respectively). Thirty-six (23.4%) eyes required a needling procedure. Conclusion XEN implant significantly lowered IOP and reduced the need of ocular hypotensive medication, while maintaining a good safety profile. Beyond week-1, there were no significant differences in IOP lowering between XEN-solo and XEN+Phacoemulsification groups.
Collapse
Affiliation(s)
- Maria Teresa Marcos-Parra
- Ophthalmology Department, Hospital General Universitario de Alicante, Alicante, Spain
- Correspondence: Maria Teresa Marcos-Parra, Ophthalmology Department, Hospital General Universitario de Alicante, Pintor Baeza, 11, Alicante, 03010, Spain, Tel +34 965 93 30 00, Email
| | | | - Carlos Mateos-Marcos
- Ophthalmology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Lucia Moreno-Castro
- Ophthalmology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Juan J Pérez-Santonja
- Ophthalmology Department, Hospital General Universitario de Alicante, Alicante, Spain
| |
Collapse
|
24
|
One-Year Outcomes of Standalone XEN Gel Stent Versus Nonpenetrating Deep Sclerectomy. J Glaucoma 2022; 31:955-965. [PMID: 36001498 DOI: 10.1097/ijg.0000000000002108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 08/07/2022] [Indexed: 12/29/2022]
Abstract
PRCIS The nonpenetrating deep sclerectomy (NPDS) procedure resulted in significantly more surgical success than the standalone XEN gel stent procedure without differences in safety profile. PURPOSE The purpose of this study was to compare surgical success and safety profile of NPDS and XEN gel stent. METHODS A retrospective chart review of 328 eyes of 282 patients who were scheduled for standalone XEN gel stent surgery (n=140) or NPDS (n=188) at Groupe Hospitalier Paris Saint-Joseph between January 2017 and December 2018 was conducted. Primary outcome measure was the proportion of surgical success 12 months after surgery. Complete and qualified surgical successes were defined by intraocular pressure (IOP)≤18 mm Hg and a reduction of IOP≥20% without or with hypotensive medication, respectively. RESULTS In total, 82 eyes were included in the XEN group and 124 eyes in the NPDS group. In the 1-eye analysis, rates of "complete success" and "qualified success" were, respectively, at the end of follow-up, 28.57% and 20.00% in the XEN group, and 42.72% and 16.50% in the NPDS group ( P =0.17). Success probability plots based on the Kaplan-Meier estimate for overall surgical success demonstrated a median success probability time of 3.73 years for the NPDS group and 2.38 years for the XEN group ( P <0.0001). After adjustment for confounding variables using Cox regression, the NPDS procedure was significantly more associated with surgical success than the XEN gel stent implantation ( P <0.001). No difference was demonstrated in terms of reduction of antiglaucoma medications, needling procedures, or reoperations. CONCLUSIONS The NPDS procedure may be more effective than the XEN gel stent in reducing IOP in patients with open angle glaucoma and may result in longer surgical success. However, a well-conducted prospective randomized study is required to confirm these results.
Collapse
|
25
|
Cutolo CA, Bonzano C, Catti C, Pizzorno C, Bagnis A, Traverso CE, Iester M. Reoperations for complications within 90 days after gel stent implantation or trabeculectomy. Int Ophthalmol 2022; 43:1745-1749. [PMID: 36418806 PMCID: PMC10149455 DOI: 10.1007/s10792-022-02575-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/12/2022] [Indexed: 11/25/2022]
Abstract
Abstract
Purpose
To describe reoperations in the operating room for complications that occurred within the first 90 days after gel stent implantation or trabeculectomy at a single institution over 5 years.
Methods
In this retrospective chart review, patients who have undergone gel stent implantation with mitomycin C (MMC) or trabeculectomy with MMC were enrolled. Postoperative complications that required reoperations within the first 90 days were evaluated.
Results
A total of 510 surgeries were performed on 392 patients over a 57-month period by 2 glaucoma surgeons. Of these, 284 were gel stent implantation, and 226 were trabeculectomy. Combined phacoemulsification was performed in 52/284 (18.3%) in the gel stent group and in 26/226 (11.5%) of eyes in the trabeculectomy group (p = 0.03). Reoperations took place in 13/510 (2.5%) eyes, including 4/284 (1.4%) in the gel stent group, 9/226 (4.0%) in the trabeculectomy group (p = 0.07). In the gel stent group, indications for reoperation were bleb failure (2), suprachoroidal hemorrhage (1), bullous keratopathy (1). In the trabeculectomy group, indications for reoperation were bleb failure (3), overfiltration (2), persistent wound leak (2), aqueous misdirection (2).
Conclusions
The rates of reoperation for early postoperative complications after gel stent or trabeculectomy was low and comparable with previous studies. A slightly higher number of reoperations within 90 days was observed in the trabeculectomy group than the gel stent group despite the more significant number of combined procedures in the latter group. Bleb failure was the most common indications for reoperation in both groups. Excessive outflow was a cause of reoperation mostly in the trabeculectomy group.
Collapse
Affiliation(s)
- Carlo A Cutolo
- DiNOGMI, Clinica Oculistica, University of Genoa, Genoa, Italy.
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Chiara Bonzano
- DiNOGMI, Clinica Oculistica, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Carlo Catti
- DiNOGMI, Clinica Oculistica, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Pizzorno
- DiNOGMI, Clinica Oculistica, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandro Bagnis
- DiNOGMI, Clinica Oculistica, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Carlo E Traverso
- DiNOGMI, Clinica Oculistica, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Michele Iester
- DiNOGMI, Clinica Oculistica, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
26
|
Park J, Shin JW, Sung KR. Comparison of surgical outcomes with and without Ologen collagen matrix augmentation during XEN gel stent implantation. BMC Ophthalmol 2022; 22:426. [PMID: 36348387 PMCID: PMC9641924 DOI: 10.1186/s12886-022-02668-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background To compare the surgical outcomes and postoperative complications with and without Ologen collagen matrix augmentation during XEN gel stent implantation. Methods We retrospectively analyzed patients who underwent XEN gel stent implantation with an ab externo technique. The amount of intraocular pressure (IOP) reduction, percentage of postoperative complications and additional management, and surgical success defined as IOP reduction greater than 20% compared with the preoperative IOP measurement were compared between Ologen-augmented and non-augmented groups. Groups of patients who underwent XEN gel stent implantation alone and combined with phacoemulsification were analyzed separately. Results A total 103 eyes of 103 participants were included. Of those, 72 eyes underwent standalone XEN gel stent implantation: 42 eyes with Ologen augmentation (Oloxen group) and 30 eyes without Ologen augmentation (Xen group). Thirty-one eyes underwent XEN gel stent implantation with phacoemulsification: 19 eyes with Ologen augmentation (Phaco-Oloxen group) and 12 eyes without Ologen augmentation (PhacoXen group). The surgical success rate at six months postoperatively was not different between the Oloxen and Xen groups (56.4% vs 43.3%, P > 0.05) or between the Phaco-Oloxen group and PhacoXen group (57.9% vs 41.7%, P > 0.05). The prevalence of postoperative hypotony, 5-fluorouracil injections, use of anti-glaucoma medications, bleb needling, and additional glaucoma surgeries was not different between the Oloxen and Xen groups or between the Phaco-Oloxen and PhacoXen groups when assessed six months postoperatively. Conclusions All groups showed significant IOP reduction after XEN gel stent implantation, but there was no significant difference between the Ologen collagen matrix augmented and non-augmented groups in surgical outcomes.
Collapse
|
27
|
Comparative Cost-effectiveness of Trabeculectomy versus MicroShunt in the US Medicare System. Ophthalmology 2022; 129:1142-1151. [PMID: 35636620 DOI: 10.1016/j.ophtha.2022.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To assess the societal cost-utility of the MicroShunt compared with trabeculectomy for the surgical management of glaucoma in the US Medicare system. DESIGN Cost-utility analysis using efficacy and safety results of a randomized controlled trial and other pivotal clinical trials. PARTICIPANTS Markov model cohort of patients with open-angle glaucoma. METHODS Open-angle glaucoma treatment costs and effects were analyzed with a deterministic model over a 1-year horizon using TreeAge software. Health states included the Hodapp-Parrish-Anderson glaucoma stages (mild, moderate, advanced, blind) and death. Both treatment arms received additional ocular hypotensive agents to control intraocular pressure (IOP). Treatment effect was measured as mean number of ocular hypotensive medications and reduction in IOP, which had a direct impact on transition probabilities between health states. Analyses of scenarios were performed with longer time horizons. One-way sensitivity and probabilistic sensitivity analyses were conducted to assess the impact of alternative model inputs. Both treatment arms were subject to reported complication rates, which were factored in the model. MAIN OUTCOME MEASURES Incremental cost per quality-adjusted life-year (QALY) gained. RESULTS At 1 year, the MicroShunt had an expected cost of US dollars (USD) 6318 compared with USD 4260 for trabeculectomy. MicroShunt patients gained 0.85 QALYs compared with 0.86 QALYs for trabeculectomy, resulting in a dominated incremental cost-utility ratio of USD 187 680. Dominance is a health economic term used to describe a treatment option that is both more costly and less effective than the alternative. The MicroShunt remained dominant in 1-way sensitivity analyses using best-case input parameters (including a device fee of USD 0). At a willingness-to-pay threshold of USD 50 000, the likelihood of the MicroShunt being cost-effective was 6.4%. Dominance continued in longer time horizons, up to 20 years. CONCLUSIONS Trabeculectomy appears to be a dominant treatment strategy over the MicroShunt in the surgical management of glaucoma. More independent, long-term studies are required for the MicroShunt and other subconjunctival microstent devices to evaluate their use in clinical practice.
Collapse
|
28
|
Ali ZC, Moshin N, Hakim MT, Shankar V. Two-year Outcomes of XEN Implantation with Minimal Bleb Needling. J Curr Glaucoma Pract 2022; 16:79-83. [PMID: 36128083 PMCID: PMC9452704 DOI: 10.5005/jp-journals-10078-1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 01/11/2022] [Indexed: 12/02/2022] Open
Abstract
Aim Our study aims to report the 2 years outcomes of the XEN implant in a single unit, single surgeon setting with minimal bleb needling. Methods A retrospective cohort study was conducted. Inclusion criteria were patients who underwent implantation with a XEN device between May 2016 and December 2017. This included patients who underwent both combined phacoemulsification and intraocular lens implantation alongside XEN implantation and those who underwent XEN implantation alone. Data gathered included basic demographic data, best-corrected visual acuity (LogMAR), intraocular pressure (IOP) in mm Hg, mean deviation from their visual field test, and the number of IOP-lowering medications they were on. This information was recorded for their preoperative visit, and then at 6, 12, 18 and 24 months postoperatively. The primary outcome assessed was a complete success when the patient was without glaucoma medications and had an IOP of 18 mm Hg or less, but more importantly, this also had to equate to a 20% reduction in IOP compared to baseline. Qualified success was defined as the same change in IOP but with medications. Surgical failure is defined as those who required additional glaucoma surgery or those who did not obtain an IOP of 18 mm Hg alongside a 20% reduction in IOP compared to baseline. Results At 24 months follow-up 82.5% of patients were surgical successes. Complete surgical success was achieved in 27% of patients. Qualified surgical success was achieved in 55.6% of patients. Subgroup analysis of those undergoing XEN implantation on its own and those combined with phacoemulsification + IOL were similar. The rate of bleb needling was low at 4.5%. Complication rates were acceptable at 9.5%. Conclusion It is possible to get good IOP control with minimal postoperative bleb needling in patients who have undergone XEN implantation. Similar success rates are found in those undergoing combined procedures. Clinical Significance Bleb needling carries its own risks. Minimizing the number of bleb needling allows procedures to be reserved at a later date. Furthermore, our study shows that success rates are not affected by doing a combined procedure with phacoemulsification. How to cite this article Ali ZC, Moshin N, Hakim MT, et al. Two-year Outcomes of XEN Implantation with Minimal Bleb Needling. J Curr Glaucoma Pract 2022;16(2):79-83.
Collapse
Affiliation(s)
- Zaria C Ali
- Department of Medical Retina, Manchester Royal Eye Hospital, Manchester, United Kingdom
- Zaria C Ali, Department of Medical Retina, Manchester Royal Eye Hospital, Manchester, United Kingdom, Phone: +91 7715233383, e-mail:
| | - Nadeem Moshin
- Department of Ophthalmology, East Lancashire Teaching Hospitals, Blackburn, United Kingdom
| | - Mohamad T Hakim
- Department of Ophthalmology, East Lancashire Teaching Hospitals, Blackburn, United Kingdom
| | - Vikas Shankar
- Department of Ophthalmology, East Lancashire Teaching Hospitals, Blackburn, United Kingdom
| |
Collapse
|
29
|
3-year Outcomes of XEN Implant Compared to Trabeculectomy, With or Without Phacoemulsification for Open-angle Glaucoma. J Glaucoma 2022; 31:826-833. [PMID: 35939830 DOI: 10.1097/ijg.0000000000002090] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022]
Abstract
PRCIS Trabeculectomy surgery reduces the intraocular pressure (IOP) more than the XEN45 implant over 3 years. There is no difference in the number of antiglaucoma medications between the two procedures. The decision to perform either trabeculectomy or XEN45 implantation must be evaluated on a case-by-case basis, taking into account the high rate of needling of the XEN45. PURPOSE The aim of this study was to compare the differences between the efficacy and safety of the XEN45 implant and trabeculectomy (TRAB), either alone or in combination with phacoemulsification (PHACO), in patients with open-angle glaucoma (OAG) at 36 months. METHODS A retrospective, single-center and comparative study conducted on OAG patients that underwent XEN45 implantation or trabeculectomy from 2016 to 2018. Patients were divided into four groups: group 1 (XEN45 alone); group 2 (XEN45+PHACO); group 3 (TRAB alone); group 4 (TRAB+PHACO). For statistical purposes, groups 1 and 2 were combined (XEN45 implant), while groups 3 and 4 were also combined (TRAB surgery). Intraocular pressure (IOP), number of antiglaucoma medications (NOAM) and adverse events were evaluated. The main outcome measure was the reduction in IOP at 36 months postoperatively. RESULTS One hundred and thirty-four patients (134 eyes; 63 XEN45 and 71 TRAB) were included. The mean (95% CI) IOP reduction at the end of the study follow-up was-6.3 (-11.0 to -1.6 mmHg, P=0.025, XEN45 alone),-8.9 (-11.0 to-6.8 mmHg, P<0.001, TRAB alone),-2.5 (-4.5 to -0.4 mmHg, P=0.019, XEN45+PHACO), and-5.6 (-7.7 to-3.4 mmHg, P<0.001, TRAB±PHACO). The proportion of patients achieving an IOP≥6 and≤16 mmHg without treatment at the end of the 36-month follow-up were 50.8% (32/63) in the XEN45 implant and 49.3% (35/71) in the TRAB surgery group, P=0.863. The mean number of antiglaucoma medications was significantly reduced in all the study groups. The needling rate was 19% in XEN45 versus 5.6% in the TRAB group (P=0.030), and 2.81% and 36.6% of eyes in the TRAB group presented anterior chamber (AC) flattening and hyphema, respectively. CONCLUSIONS Trabeculectomy surgery lowered IOP significantly more than XEN45 implant with or without phacoemulsification over 3 years and had a significantly lower need for additional needling surgery. Both procedures reduce the number of antiglaucoma medications to a similar rate. These findings are relevant to the informed consent process and patient decisions for one procedure over the other.
Collapse
|
30
|
Schlatter A, Rauchegger T, Schmid E, Teuchner B. Effects of glaucoma surgery on visual field progression in open-angle glaucoma considering the floor effect. Acta Ophthalmol 2022; 100:e1127-e1134. [PMID: 34708544 PMCID: PMC9544081 DOI: 10.1111/aos.15048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 10/01/2021] [Accepted: 10/06/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this retrospective analysis was to investigate whether trabeculectomy (TRAB) and XEN® Gel Stent implantation (XEN) - both filtrating surgery techniques - can slow down the deterioration of visual field (VF) parameters considering the floor effect, which could lead to a misestimation of pre- and postoperative VF rate of progression (ROP). METHODS Included in this study were patients with open-angle glaucoma, who underwent either TRAB or XEN® gel stent implantation and who had at least three VF tests before and after surgery, over an observation period of 13 years. The annual ROP of the mean defect (MD) and the square root of loss variance (sLV) were calculated with two different censoring thresholds: by censored regression and by ordinary least squares regression (OLSR). In addition, the diagnostic range of sLV was calculated. RESULTS 48 eyes of 39 glaucoma patients were included in the study. The annual rate of MD progression was significantly reduced by filtering surgery when calculating the yearly ROP using OLSR (p = 0.006) and by censoring values exceeding a precalculated cut-off of 14.20 dB (p = 0.041) and a cut-off from the literature of 15.00 dB (p = 0.028). On average, the MD was impacted by a significant floor effect of 14.20 dB (95% CI: 12.83-15.56), corresponding to 17.7/59 absolute defects or 29.9% of the whole VF. When applying both OLSR and censored regression, the annual rate of sLV progression did not show a significant difference. The sLV showed a diagnostic boundary at a MD of 15.78 dB. CONCLUSION This study shows that filtering surgery can reduce the progression of VF in patients with open-angle glaucoma, especially those whose disease develops aggressively. This is valid even if the floor effect in advanced cases is compensated by censored regression. On average, the ROP of MD is affected by a significant floor effect at about 29.9% absolute loss of the whole VF.
Collapse
Affiliation(s)
- Andreas Schlatter
- Department of Ophthalmology and OptometryMedical University of InnsbruckAnichstrasse 35Innsbruck6020Austria
| | - Teresa Rauchegger
- Department of Ophthalmology and OptometryMedical University of InnsbruckAnichstrasse 35Innsbruck6020Austria
| | - Eduard Schmid
- Department of Ophthalmology and OptometryMedical University of InnsbruckAnichstrasse 35Innsbruck6020Austria
| | - Barbara Teuchner
- Department of Ophthalmology and OptometryMedical University of InnsbruckAnichstrasse 35Innsbruck6020Austria
| |
Collapse
|
31
|
Yang X, Zhao Y, Zhong Y, Duan X. The efficacy of XEN gel stent implantation in glaucoma: a systematic review and meta-analysis. BMC Ophthalmol 2022; 22:305. [PMID: 35836197 PMCID: PMC9284889 DOI: 10.1186/s12886-022-02502-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/16/2022] [Indexed: 01/10/2023] Open
Abstract
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. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02502-y.
Collapse
Affiliation(s)
- Xiang Yang
- Changsha Aier Eye Hospital, Changsha, Hunan, China
| | - Yang Zhao
- Changsha Aier Eye Hospital, Changsha, Hunan, China
| | - Yu Zhong
- Changsha Aier Eye Hospital, Changsha, Hunan, China.,Aier School of Ophthalmology, Central South University, Changsha, Hunan, China
| | - Xuanchu Duan
- Changsha Aier Eye Hospital, Changsha, Hunan, China. .,Aier School of Ophthalmology, Central South University, Changsha, Hunan, China.
| |
Collapse
|
32
|
Fea AM, Menchini M, Rossi A, Posarelli C, Malinverni L, Figus M. Outcomes of XEN 63 Device at 18-Month Follow-Up in Glaucoma Patients: A Two-Center Retrospective Study. J Clin Med 2022; 11:jcm11133801. [PMID: 35807088 PMCID: PMC9267545 DOI: 10.3390/jcm11133801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/24/2022] [Accepted: 06/13/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Glaucoma surgery has significantly evolved over the last years. This paper aims to evaluate the midterm clinical outcomes of the XEN63 device in a real-world scenario. Methods: A retrospective clinical study was conducted on consecutive patients who underwent an XEN63 implant insertion, either alone or in combination with phacoemulsification. The primary endpoint was the mean intraocular pressure (IOP) at the month 18 visit. Results: Twenty-three eyes (23 patients) were included in the analysis. The preoperative IOP was significantly lowered from 27.0 ± 7.8 mmHg to 14.1 ± 3.4 mmHg at month 18 (p < 0.0001). At month 18, 14 (77.8%) and 11 (61.1%) eyes had an IOP ≤ 16 mmHg and ≤ 14 mmHg, respectively, without ocular hypotensive medication. The mean number of ocular hypotensive medication taken was significantly reduced from 2.3 ± 0.9 drugs at baseline to 1.0 ± 1.4 drugs at month 18 (p = 0.0020). Four (17.4%) eyes had hypotony at postoperative day 1, which was successfully resolved without sequelae. Four (17.4%) eyes underwent a needling procedure and four (17.4%) eyes underwent additional surgeries. Conclusions: The XEN63, either alone or in combination with cataract surgery, significantly lowered the IOP and reduced the need for ocular hypotensive drugs over a period of 18 months.
Collapse
Affiliation(s)
- Antonio Maria Fea
- Struttura Complessa Oculistica, Città Della Salute e Della Scienza di Torino, Dipartimento di Scienze Chirurgiche-Università degli Studi di Torino, 10126 Torino, Italy; (A.R.); (L.M.)
- Correspondence: ; Tel.: +39-349-560-1674
| | - Martina Menchini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine-University of Pisa, 56126 Pisa, Italy; (M.M.); (C.P.); (M.F.)
| | - Alessandro Rossi
- Struttura Complessa Oculistica, Città Della Salute e Della Scienza di Torino, Dipartimento di Scienze Chirurgiche-Università degli Studi di Torino, 10126 Torino, Italy; (A.R.); (L.M.)
| | - Chiara Posarelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine-University of Pisa, 56126 Pisa, Italy; (M.M.); (C.P.); (M.F.)
| | - Lorenza Malinverni
- Struttura Complessa Oculistica, Città Della Salute e Della Scienza di Torino, Dipartimento di Scienze Chirurgiche-Università degli Studi di Torino, 10126 Torino, Italy; (A.R.); (L.M.)
| | - Michele Figus
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine-University of Pisa, 56126 Pisa, Italy; (M.M.); (C.P.); (M.F.)
| |
Collapse
|
33
|
Monja-Alarcón N, Perucho-Martínez S, Buenasmañanas-Maeso M, Toledano-Fernández N. Does mitomycin-C concentration have any influence on XEN45 gel stent outcomes in a real-world setting? Graefes Arch Clin Exp Ophthalmol 2022; 260:2649-2661. [PMID: 35230475 DOI: 10.1007/s00417-022-05603-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND To compare the effectiveness and safety of XEN45 implanted with mitomycin-C (MMC) 0.01% versus (vs) XEN45 implanted with MMC 0.02%. METHODS Retrospective and single-center study conducted on consecutive patients with open-angle glaucoma or ocular hypertension who underwent XEN45-implant, either alone or in combination with cataract surgery. The primary end-point was the mean change in intraocular pressure (IOP) from baseline to the last follow-up visit. RESULTS Fifty-five patients (63 eyes) were included. Thirty-seven (58.7%) eyes underwent surgery with MMC 0.01% and 26 (41.3%) ones with MMC 0.02%. In the overall study sample, the mean (standard error) IOP was significantly lowered from 17.6 (0.7) mm Hg at baseline to 12.6 (0.3) mm Hg at month 12. The IOP was significantly lowered from 17.3 (15.4 to 19.2) mm Hg and 17.9 (16.1 to 17.8) mm Hg at baseline to 12.3 (11.3 to 13.3) mm Hg and 13.1 (12.3 to 13.9) mm Hg at month 12 in the MMC 0.01% and MMC 0.02% groups, respectively; p < 0.0001 each. The mean number of ocular-hypotensive medications significantly decreased from 2.1 (1.9 to 2.3) at baseline to 0.2 (0.04 to 0.3) at month 12, p < 0.0001, with no significant differences between MMC 0.01% and MMC 0.02% groups, p = 0.5181. At month 12, 50 (80.6%) eyes had functioning blebs. Regarding safety, 18 (28.6%) eyes have experience adverse events. CONCLUSION XEN45, either alone or in combination with cataract surgery, showed a good effectiveness and safety profile. MMC dose had no influence on the IOP lowering, which may support the use of the lowest dose.
Collapse
Affiliation(s)
- Natalia Monja-Alarcón
- Ophthalmology Department, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain.
| | - Susana Perucho-Martínez
- Ophthalmology Department, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain.
| | - Miriam Buenasmañanas-Maeso
- Ophthalmology Department, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain.
| | - Nicolás Toledano-Fernández
- Ophthalmology Department, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain
| |
Collapse
|
34
|
Buenasmañanas-Maeso M, Perucho-Martínez S, Monja-Alarcón N, Toledano-Fernández N. Impact of Primary Needling on the XEN Implant Clinical Outcomes: A Real-Life Retrospective Study. Clin Ophthalmol 2022; 16:935-946. [PMID: 35368242 PMCID: PMC8974446 DOI: 10.2147/opth.s357575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/16/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the effectiveness and safety of primary-needling in eyes who underwent a XEN45 implant. Methods Retrospective and single center study. Consecutive patients with early-to-moderate open-angle glaucoma (OAG) or ocular hypertension, who underwent XEN45 surgery, either alone or combined with phacoemulsification, and had at least a valid 12-month post-operative visit, were included in the study. Primary needling was performed by using a 30-gauge needle without viscoelastic. Subjects were divided in two groups: Eyes who underwent XEN+primary-needling (needling) and those who underwent XEN without primary-needling (no-needling). The primary end-point was the mean change in IOP from baseline to the last follow-up visit. Results Sixty-three eyes, 19 (30.2%) in the needling group and 44 (69.8%) in the no-needling one, were included in the study. There were not significant differences in mean IOP lowering between needling and no-needling groups at month-12 (mean difference −2.5±5.3 mm Hg, p=0.0926). No significant differences in mean reduction of ocular-hypotensive medications were observed between needling and no-needling groups, p=0.8690. At month-12, 50 (80.6%) had blebs considered as functioning, with no difference between groups, p = 0.5631. At month-12, 59 (93.7%) eyes were classified as success, with no significant differences between needling (17/19) and no-needling (42/44) groups, p=0.3754. Secondary needling was performed in 8 (12.7%) eyes, without differences between groups (p=0.6333). Conclusion Primary needling, at the time of surgery, was a safe procedure in OAG patients who underwent a XEN implant, although it was not associated with a lower postoperative IOP or less ocular hypotensive medications.
Collapse
Affiliation(s)
- Miriam Buenasmañanas-Maeso
- Ophthalmology Department, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
- Correspondence: Miriam Buenasmañanas-Maeso, Ophthalmology Department, Hospital Universitario de Fuenlabrada, Camino del Molino 2, Fuenlabrada, 28942, Madrid, Spain, Tel +34 646540854, Email
| | | | - Natalia Monja-Alarcón
- Ophthalmology Department, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | | |
Collapse
|
35
|
Gambini G, Carlà MM, Giannuzzi F, Caporossi T, De Vico U, Savastano A, Baldascino A, Rizzo C, Kilian R, Caporossi A, Rizzo S. PreserFlo® MicroShunt: An Overview of This Minimally Invasive Device for Open-Angle Glaucoma. Vision (Basel) 2022; 6:vision6010012. [PMID: 35225971 PMCID: PMC8883991 DOI: 10.3390/vision6010012] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 01/25/2023] Open
Abstract
For moderate-to-severe glaucoma, trabeculectomy remains the “gold standard” intraocular pressure (IOP)-lowering treatment; nonetheless, this method requires extensive post-operative maintenance. Microinvasive glaucoma surgery (MIGS) treatments are designed to lessen intra- and post-operative care burden while offering an acceptable IOP decrease for individuals with mild to moderate glaucoma. The PreserFlo® MicroShunt (previously InnFocus MicroShunt) is an 8.5 mm glaucoma drainage device manufactured from poly(styrene-block-isobutylene-block-styrene) (SIBS), an extremely biocompatible and bioinert material. The lumen is narrow enough to prevent hypotony, but big enough to avoid being obstructed by sloughed cells or pigment. The device is implanted ab externo, as a stand-alone procedure or in conjunction with cataract surgery, with intraoperative mitomycin C, and a bleb is produced under the conjunctiva and Tenon’s capsule. The MicroShunt was CE-marked in 2012 and designed for primary open-angle glaucoma, the IOP of which remains uncontrolled after maximally tolerated topical treatment. Several clinical trials evaluating the MicroShunt’s long-term safety and effectiveness have been conducted, highlighting the effectiveness of the device over time, along with a tolerable safety profile. The present review aims to gather evidence of PreserFlo’s effectiveness and safety results almost 10 years after its introduction, and furthermore, to compare it with other MIGS and with the gold-standard trabeculectomy for glaucoma management.
Collapse
Affiliation(s)
- Gloria Gambini
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (T.C.); (U.D.V.); (A.S.); (A.B.); (A.C.); (S.R.)
- Ophthalmology Unit, Catholic University “Sacro Cuore”, 00168 Rome, Italy
- Correspondence: (G.G.); (M.M.C.); (F.G.); Tel.: +39-3276530138 (M.M.C.)
| | - Matteo Mario Carlà
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (T.C.); (U.D.V.); (A.S.); (A.B.); (A.C.); (S.R.)
- Ophthalmology Unit, Catholic University “Sacro Cuore”, 00168 Rome, Italy
- Correspondence: (G.G.); (M.M.C.); (F.G.); Tel.: +39-3276530138 (M.M.C.)
| | - Federico Giannuzzi
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (T.C.); (U.D.V.); (A.S.); (A.B.); (A.C.); (S.R.)
- Ophthalmology Unit, Catholic University “Sacro Cuore”, 00168 Rome, Italy
- Correspondence: (G.G.); (M.M.C.); (F.G.); Tel.: +39-3276530138 (M.M.C.)
| | - Tomaso Caporossi
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (T.C.); (U.D.V.); (A.S.); (A.B.); (A.C.); (S.R.)
- Ophthalmology Unit, Catholic University “Sacro Cuore”, 00168 Rome, Italy
| | - Umberto De Vico
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (T.C.); (U.D.V.); (A.S.); (A.B.); (A.C.); (S.R.)
- Ophthalmology Unit, Catholic University “Sacro Cuore”, 00168 Rome, Italy
| | - Alfonso Savastano
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (T.C.); (U.D.V.); (A.S.); (A.B.); (A.C.); (S.R.)
- Ophthalmology Unit, Catholic University “Sacro Cuore”, 00168 Rome, Italy
| | - Antonio Baldascino
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (T.C.); (U.D.V.); (A.S.); (A.B.); (A.C.); (S.R.)
- Ophthalmology Unit, Catholic University “Sacro Cuore”, 00168 Rome, Italy
| | - Clara Rizzo
- Ophthalmology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Raphael Kilian
- Ophthalmology Unit, University of Verona, 37134 Verona, Italy;
| | - Aldo Caporossi
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (T.C.); (U.D.V.); (A.S.); (A.B.); (A.C.); (S.R.)
- Ophthalmology Unit, Catholic University “Sacro Cuore”, 00168 Rome, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (T.C.); (U.D.V.); (A.S.); (A.B.); (A.C.); (S.R.)
- Ophthalmology Unit, Catholic University “Sacro Cuore”, 00168 Rome, Italy
| |
Collapse
|
36
|
Chen XZ, Liang ZQ, Yang KY, Lv K, Ma Y, Li MY, Wu HJ. The Outcomes of XEN Gel Stent Implantation: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:804847. [PMID: 35186992 PMCID: PMC8854748 DOI: 10.3389/fmed.2022.804847] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/03/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose XEN 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. Methods We 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. Results Five 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%. Conclusions XEN 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.
Collapse
|
37
|
Paletta Guedes RA, Gravina DM, Paletta Guedes VM, Chaoubah A. Standalone Implantation of 2-3 Trabecular Micro-Bypass Stents (iStent inject ± iStent) as an Alternative to Trabeculectomy for Moderate-to-Severe Glaucoma. Ophthalmol Ther 2022; 11:271-292. [PMID: 34825352 PMCID: PMC8770764 DOI: 10.1007/s40123-021-00424-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION This retrospective consecutive study compared standalone implantation of multiple (2-3) trabecular micro-bypass stents (iStent inject ± iStent) (Multi-Stent group) vs trabeculectomy + mitomycin C (Trab group) in moderate to severe open-angle glaucoma (OAG). METHODS Eligible patients underwent Multi-Stent or Trab surgery from 2018 to 2020 and had at least 3-month follow-up; visual field mean deviation (VF MD) - 6 dB or worse; inadequate prior response to maximum medications ± laser procedures; and had trabeculectomy as their next planned intervention. Primary effectiveness, safety-adjusted treatment success, was defined as ≥ 20% intraocular pressure (IOP) reduction on the same or fewer medications, without clinically significant safety events (severe complications, secondary surgeries, reinterventions). Secondary effectiveness included mean IOP and medications; qualified and complete attainment of target IOP (≤ 21/18/15/12 mmHg and > 6 mmHg); health-economic and quality-of-life (QoL) measures; and 2-vs-3-stent subgroup analysis. RESULTS The baseline groups (n = 70 Multi-Stent/40 Trab) were similar: mean IOP (21.1 mmHg/22.3 mmHg); medications (2.87/3.10 medications); disease stage (30%/35% severe); VF MD (- 10.1 dB/- 10.4 dB); and mean last follow-up (LFU, 13.1 months/15.7 months) (all differences non-significant). Primary effectiveness: treatment success at LFU was 62.9% vs 30.0% in Multi-Stent vs Trab eyes, respectively (p = 0.001). Secondary effectiveness: At LFU in Multi-Stent vs Trab groups, respectively: mean IOP decreased by 31% to 14.2 mmHg (p < 0.001) vs by 43% to 12.5 mmHg (p < 0.001); mean medications decreased by 51% to 1.31 medications (p < 0.001) vs by 84% to 0.43 medications (p < 0.001). Multi-Stent eyes, compared to Trab eyes, had fewer visits ± reinterventions within 3 months (3.6 vs 6.1, p < 0.001); longer time to first reintervention (12.2 months vs 4.5 months, p = 0.01); fewer total reinterventions (0.26 vs 0.75, p = 0.006); and earlier lifting of postoperative restrictions (12.6 vs 32.1 days, p < 0.001). In 2-vs-3-stent analysis, there was a trend toward more 3-stent eyes achieving target IOP than 2-stent eyes. Visual fields remained stable in both Multi-Stent and Trab eyes. CONCLUSION Implanting 2-3 trabecular micro-bypass stents was a viable alternative to trabeculectomy for moderate-to-severe OAG, with clinically appropriate IOP/medication reductions and higher safety-adjusted treatment success vs trabeculectomy.
Collapse
Affiliation(s)
- Ricardo Augusto Paletta Guedes
- Paletta Guedes Eye Institute, Juiz de Fora, Brazil.
- Federal University of Juiz de Fora, 79, Oscar Vidal Street, Juiz de Fora, MG, Brazil.
| | | | | | - Alfredo Chaoubah
- Federal University of Juiz de Fora, 79, Oscar Vidal Street, Juiz de Fora, MG, Brazil
| |
Collapse
|
38
|
Cappelli F, Cutolo CA, Olivari S, Testa V, Sindaco D, Pizzorno C, Ciccione S, Traaverso CE, Iester M. Trabeculectomy versus Xen gel implant for the treatment of open-angle glaucoma: a 3-year retrospective analysis. BMJ Open Ophthalmol 2022; 7:e000830. [PMID: 35047670 PMCID: PMC8728414 DOI: 10.1136/bmjophth-2021-000830] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 11/16/2021] [Indexed: 12/05/2022] Open
Abstract
Objective To compare the two surgical techniques in terms of efficacy, safety, and postoperative management over 36 months of follow-up. Methods This retrospective clinical cohort study compared the outcome of trabeculectomy surgery and Xen gel implant in patients having uncontrolled glaucoma. Patients were recruited using the following inclusion criteria: uncontrolled intraocular pressure (IOP) on maximally tolerated medical therapy, healthy conjunctiva freely mobile in the superior sector, open-angle, glaucomatous visual field damage, full follow upfollow-up of at least 36 months. Thirty-four patients were submitted to trabeculectomy and 34 to Xen gel implant. We set the lower limit at 6mmHg mm Hg and the upper limit ≤12 mm Hg for criteria A, upper limit to ≤15 mm Hg for criteria B and upper limit ≤18 mm Hg for criteria C. Criteria for success have been characterizedcharacterised according to whether or not this has been achieved without (complete success) or with IOP -lowering medications (qualified success). Results For all survival curves, trabeculectomy was superior to Xen gel implant. When considering complete success, the log-rank test for criteria A was statistically significant (pp=0.006), marginally significant for criteria B (pp=0.065) and not significant for criteria C (pp=0.23). When qualified success was considered, trabeculectomy was superior to Xen gel for criteria A, B, and C (pp=0.012, pp=0.033 and pp=0.025, respectively). Higher number of post-operative flat chamber and bleb leakage was observed in the trabeculectomy group. Conclusion Xen gel implant techniques offer a better safety profile but a lower IOP reduction compared to compared with the gold -standard technique.
Collapse
Affiliation(s)
- Francesca Cappelli
- Eye Clinic, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Liguria, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Carlo Alberto Cutolo
- Eye Clinic, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Liguria, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Sara Olivari
- Eye Clinic, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Liguria, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Valeria Testa
- Eye Clinic, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Liguria, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Daniele Sindaco
- Eye Clinic, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Liguria, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Pizzorno
- Eye Clinic, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Liguria, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Sara Ciccione
- Eye Clinic, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Liguria, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Carlo Enrico Traaverso
- Eye Clinic, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Liguria, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Michele Iester
- Eye Clinic, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Liguria, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| |
Collapse
|
39
|
Yang LIMS, Kaijun BETZLERB, Leonard YIPWL, Syril DORAIRAJ, Hou ANGBC. Standalone XEN45 Gel Stent implantation in the treatment of open- angle Glaucoma: A systematic review and meta-analysis. Surv Ophthalmol 2022; 67:1048-1061. [DOI: 10.1016/j.survophthal.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 01/11/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
|
40
|
Kee AR, Vivien Yip CH, Chua CH, Bryan Ang CH, Jeremy Hu Y, Guo X, Leonard Yip WL. Comparison of Efficacy and Safety of XEN45 Implant Versus Trabeculectomy in Asian Eyes. J Glaucoma 2021; 30:1056-1064. [PMID: 34731866 DOI: 10.1097/ijg.0000000000001954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/21/2021] [Indexed: 10/19/2022]
Abstract
PRCIS Combined phacoemulsification and trabeculectomy is able to achieve greater reduction in intraocular pressure (IOP), higher rates of complete surgical success and fewer postoperative manipulations and visits compared with combined phacoemulsification and Xen implantation in glaucomatous eyes. PURPOSE Our study aims to compare and understand the differences between the efficacy and safety of XEN45 implantation and trabeculectomy in Asian eyes with glaucoma. MATERIALS AND METHODS This was a retrospective, single-center, comparative study of consecutive patients who underwent combined phacoemulsification and trabeculectomy (Phaco-Trab) from January 2013 to June 2014 and combined phacoemulsification and XEN45 implantation (Phaco-Xen) from May 2017 to September 2018 in a tertiary Ophthalmology center in Singapore. Outcome measures included IOP, number of anti-glaucoma eyedrops, success rate, factors leading to success/failure, number of postoperative interventions and visits required, and surgical complications. RESULTS A total of 137 eyes (91 Phaco-Trab, 46 Phaco-Xen) were included. Phaco-Trab group had greater mean IOP reduction at all time points beyond postoperative month (POM) 1 (mean difference 2.9 to 3.8 mm Hg; P<0.05), and greater reduction in mean number of antiglaucoma eyedrops beyond POM3, thought this was not statistically significant. At POM12, complete success was achieved in 83.5% in Phaco-Trab and 52.2% of Phaco-Xen group, respectively (P<0.001). There was no significant factor associated with surgical failure, other than the difference in surgical procedure. Phaco-Trab group required fewer number of postoperative interventions (P=0.009), with only a mean of 0.1 bleb interventions required per patient, versus 1.5 in Phaco-Xen group (P<0.001). Safety profiles in both groups were comparable, with no statistically significant difference in intraoperative/postoperative complications. CONCLUSION Phaco-Trab has significantly higher reduction in both IOP and number of antiglaucoma medications compared with Phaco-Xen group, with greater surgical success and fewer postoperative manipulations and visits. Safety profiles were comparable.
Collapse
Affiliation(s)
- Ae Ra Kee
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital
| | | | - Chun Hau Chua
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital
| | | | | | - Xiner Guo
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital
| | - Wei Leon Leonard Yip
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| |
Collapse
|
41
|
Kim DS, Kim SH, Choi Y, Choi SK, Lee JJ, Park SW, Byon IS. Streptococcus infantarius Endophthalmitis after XEN Gel Stent Implantation. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.10.1440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To report a case of Streptococcus infantarius endophthalmitis related to the use of a XEN® Gel Stent.Case summary: A 75-year-old male was referred to our practice with a diagnosis of endophthalmitis 55 days after XEN® Gel Stent implantation. He had primary open-angle glaucoma. Visual acuity was 20/50. Slit-lamp examination revealed conjunctival injection and anterior chamber inflammation with hypopyon. Fundus examination showed inflammatory cells with exudative materials in the vitreous. The aqueous sampling for culture of causative micro-organisms was followed by removal of the XEN® Gel Stent, along with anterior chamber irrigation and intracameral and intravitreal injection of antibiotics. Streptococcus infantarius was isolated after 5 days. Vitrectomy, anterior chamber lavage, and intravitreal injection of antibiotics were additionally performed to control the intraocular inflammation. Sixteen days after vitrectomy, the intraocular inflammation disappeared. The choroidal detachment was resolved 34 days after vitrectomy. Visual improvement was limited to 20/100 at 6 months.Conclusions: XEN® Gel Stent-related bacterial endophthalmitis was successfully treated by implant removal, vitrectomy, and proper intraocular antibiotic treatment.
Collapse
|
42
|
Wagner FM, Schuster AK, Munder A, Muehl M, Chronopoulos P, Pfeiffer N, Hoffmann EM. Comparison of subconjunctival microinvasive glaucoma surgery and trabeculectomy. Acta Ophthalmol 2021; 100:e1120-e1126. [PMID: 34626093 DOI: 10.1111/aos.15042] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/11/2021] [Accepted: 09/22/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE To assess surgical success and the post-operative development of intraocular pressure between XEN45® gelstent, Preserflo® MicroShunt and trabeculectomy with mitomycin C. METHODS Data from 105 eyes from 105 patients of matched cases with refractory open-angle glaucoma, who underwent surgery between January 2019, and August 2020, were evaluated. Patients underwent either stand-alone XEN gelstent insertion with Mitomycin C, stand-alone Preserflo with Mitomycin C or trabeculectomy with Mitomycin C. The primary outcome was the proportion of complete surgical success at 6 months post-operatively (i.e. intraocular pressure between 5mmHg and 18mmHg, no revision surgery, no loss of light perception and no post-operative pharmaceutical antiglaucomatous treatment). The reduction of intraocular pressure after 6 months, the classes of antiglaucomatous medication used post-operatively, best-corrected visual acuity, spherical refractive errors and astigmatism were assessed as secondary outcomes. RESULTS We included 35 eyes in each group. After 6-month follow-up, complete success was 73.5% [95%-CI: 57.9%-89.2%] in the trabeculectomy group, 51.4% [95%-CI: 34.0%-68.8%] in the XEN group and 74.2% [95%-CI: 57.9%-90.5%] in the Preserflo group (p = 0.08). Regarding secondary outcomes, the reduction of intraocular pressure was 12.1 ± 7.9 mmHg in the trabeculectomy group and was thereby 5.8 [95%-CI: 2.2-9.6] mmHg greater compared with the XEN group (p < 0.001) and 4.8 [95%-CI: 0.9-8.7] mmHg higher than the Preserflo group (p = 0.01). CONCLUSIONS No statistically significant differences were found between trabeculectomy, XEN45® gelstent implantation and Preserflo® MicroShunt implantation regarding surgical success after 6 months. Yet reduction in intraocular pressure was significantly higher in the trabeculectomy group. However, all three interventions resulted in sufficiently low post-operative intraocular pressure and may therefore be considered individually for glaucoma treatment.
Collapse
Affiliation(s)
- Felix M. Wagner
- Department of Ophthalmology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Alexander K. Schuster
- Department of Ophthalmology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Annika Munder
- Department of Ophthalmology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Marius Muehl
- Department of Ophthalmology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | | | - Norbert Pfeiffer
- Department of Ophthalmology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| | - Esther M. Hoffmann
- Department of Ophthalmology University Medical Center of the Johannes Gutenberg‐University Mainz Mainz Germany
| |
Collapse
|
43
|
Eraslan M, Özcan AA, Dericioğlu V, Çiloğlu E. Multicenter case series of standalone XEN implant vs. combination with phacoemulsification in Turkish patients. Int Ophthalmol 2021. [PMID: 34050406 DOI: 10.3760/cma.j.cn112137-20210625-01436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE To evaluate and compare the efficacy, safety and needling timing and rates of standalone XEN implant vs. combination with phacoemulsification in Turkish patients. METHODS Retrospective, multicenter study which included the data of patients, who had open angle glaucoma including primary open angle glaucoma and pseudoexfoliation glaucoma, underwent standalone XEN implantation (XEN alone) and combined surgery with phacoemulsification (XEN + Phaco) between 2016 and 2018. RESULTS The study included 26 eyes of 24 patients in XEN alone group and 32 eyes of 30 patients in XEN + Phaco group. The mean intraocular pressure (IOP) was 23.3 ± 6.0 mmHg and 24.4 ± 7.4 mmHg at baseline (p = 0.838), and it reduced to 16.3 ± 3.0 mmHg and 16.4 ± 2.3 mmHg at 12-month follow-up (p = 0.436) in XEN alone and XEN + Phaco groups, respectively (reduction: %30 and %33, P = 0.642). The mean number of medications reduced from 2.9 + 0.7 before surgery to 0.9 + 0.9 on month 12. In XEN alone and XEN + Phaco groups, the needling rates were 42.3% and 31.2% (p = 0.491), and the mean time to needling was 3.7 ± 3.2 months and 4.9 ± 8.0 months (p = 0.696), respectively. Hypotonia (17.2%) and hyphema (10.3%) were the most frequent complications, respectively. In XEN alone and XEN + Phaco groups, partial success was achieved in 73.1% and 71.9% of eyes when defined as IOP < 18 mmHg with any medication, respectively (p = 0.920). CONCLUSION The XEN implant provides significant reduction in IOP and number of medications, either standalone or combination with phacoemulsification. Both procedures need intensive postoperative care, requiring needling in approximately one-third of patients.
Collapse
Affiliation(s)
- Muhsin Eraslan
- Department of Ophthalmology, Marmara University School of Medicine, Marmara Universitesi Pendik Egitim Arastirma Hastanesi Goz Hastaliklari Anabilim Dali Departmani Fevzi Cakmak Mah. Muhsin Yazicioglu Cad. No: 10 Ust Kaynarca/Pendik, Istanbul, 34890, Turkey
| | - Altan Atakan Özcan
- Department of Ophthalmology, Çukurova University School of Medicine, Adana, Turkey
| | - Volkan Dericioğlu
- Department of Ophthalmology, Marmara University School of Medicine, Marmara Universitesi Pendik Egitim Arastirma Hastanesi Goz Hastaliklari Anabilim Dali Departmani Fevzi Cakmak Mah. Muhsin Yazicioglu Cad. No: 10 Ust Kaynarca/Pendik, Istanbul, 34890, Turkey.
| | - Emine Çiloğlu
- Department of Ophthalmology, Adana City Training and Research Hospital, Adana, Turkey
| |
Collapse
|
44
|
Lewczuk K, Konopińska J, Jabłońska J, Rudowicz J, Laszewicz P, Dmuchowska DA, Mariak Z, Rękas M. XEN Glaucoma Implant for the Management of Glaucoma in Naïve Patients versus Patients with Previous Glaucoma Surgery. J Clin Med 2021; 10:jcm10194417. [PMID: 34640435 PMCID: PMC8509378 DOI: 10.3390/jcm10194417] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/12/2021] [Accepted: 09/23/2021] [Indexed: 01/04/2023] Open
Abstract
This retrospective study analyzed the surgical and refractive outcomes of a XEN Gel Implant (Allergan, Abbvie Company, Irvine, CA, USA) in naïve patients versus those with previous glaucoma surgery. We evaluated the efficacy of XEN implantation in 86 glaucoma patients during a long-term follow-up period. Patients were divided into two groups: naïve patients (Group 1) and patients with previous glaucoma surgery (Group 2). Eyes that received a XEN Gel Stent placement from December 2014 to October 2019 were included. Intraocular pressure (IOP) change, corrected distance visual acuity (CDVA), change in glaucoma medications, frequency of slit lamp revision procedures, and frequency of secondary glaucoma surgeries were the primary outcomes. In Group 1, the mean IOP before surgery was decreased significantly from 25.00 ± 7.52 mmHg to 16.83 ± 5.12 mmHg by the end of the study. In Group 2, the mean IOP decreased significantly from 25.35 ± 7.81 mmHg to 17.54 ± 5.34 mmHg. The mean IOP decrease from baseline was 29% in Group 1 and 27% in Group 2 (p = 0.567). There were no significant differences between the groups in the IOP baseline level, the final level, or the change between preoperative and final levels. The qualified success rate for Group 2 was 68.7% versus 76.5% for Group 1 for the initial procedure and 15.4% vs. 20.2%, respectively, for complete success rate (p > 0.05). However, at the end of the follow-up, more patients achieved an IOP < 18 mmHg in Group 1 than in Group 2. Despite the need for more anti-glaucoma medications, repeat XEN Gel implantation appears to show promising results in patients with previously failed anti-glaucoma procedures, owing to its minimal invasiveness.
Collapse
Affiliation(s)
- Katarzyna Lewczuk
- Department of Ophthalmology, Military Institute of Medicine, 04-141 Warsaw, Poland; (K.L.); (J.J.); (J.R.); (P.L.); (M.R.)
| | - Joanna Konopińska
- Department of Ophthalmology, Medical University in Bialystok, M. Sklodowska-Curie 24A STR, 15-276 Bialystok, Poland; (D.A.D.); (Z.M.)
- Correspondence: ; Tel.: +48-857468372
| | - Joanna Jabłońska
- Department of Ophthalmology, Military Institute of Medicine, 04-141 Warsaw, Poland; (K.L.); (J.J.); (J.R.); (P.L.); (M.R.)
| | - Jacek Rudowicz
- Department of Ophthalmology, Military Institute of Medicine, 04-141 Warsaw, Poland; (K.L.); (J.J.); (J.R.); (P.L.); (M.R.)
| | - Patrycja Laszewicz
- Department of Ophthalmology, Military Institute of Medicine, 04-141 Warsaw, Poland; (K.L.); (J.J.); (J.R.); (P.L.); (M.R.)
| | - Diana Anna Dmuchowska
- Department of Ophthalmology, Medical University in Bialystok, M. Sklodowska-Curie 24A STR, 15-276 Bialystok, Poland; (D.A.D.); (Z.M.)
| | - Zofia Mariak
- Department of Ophthalmology, Medical University in Bialystok, M. Sklodowska-Curie 24A STR, 15-276 Bialystok, Poland; (D.A.D.); (Z.M.)
| | - Marek Rękas
- Department of Ophthalmology, Military Institute of Medicine, 04-141 Warsaw, Poland; (K.L.); (J.J.); (J.R.); (P.L.); (M.R.)
| |
Collapse
|
45
|
Ramovecchi V, Franco F, Barbera GR. XEN Gel Staining with Trypan Blue: A Simple and Effective Technique to Improve Device Visualization during Implantation. J Curr Glaucoma Pract 2021; 15:161-163. [PMID: 35173400 PMCID: PMC8807932 DOI: 10.5005/jp-journals-10078-1318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Xen Gel Stent (Allergan, Irvine, CA, USA) is a hydrophilic collagen-based gelatin tube of 6 mm in length which creates a channel of communication between the anterior chamber and the subconjunctival space allowing aqueous humor outflow. XEN is an ab interno, minimally invasive, glaucoma surgery device which has a better safety profile and offers a less invasive way of lowering intraocular pressure. Unfortunately, one of its weaknesses is that visualization of the implant during surgery is difficult, and this difficulty may be exacerbated, for instance, by a subconjunctival hemorrhage. The purpose of this paper is to describe a simple and effective technique for improving device visualization (XEN 45 μm) during the implantation. How to cite this article: Ramovecchi V, Franco F, Barbera GR. XEN Gel Staining with Trypan Blue: A Simple and Effective Technique to Improve Device Visualization during Implantation. J Curr Glaucoma Pract 2021;15(3):161-163.
Collapse
Affiliation(s)
- Vincenzo Ramovecchi
- Department of Ophthalmology, Ospedale di San Severino Marche e Macerata, Italy
| | - Fabrizio Franco
- Department of AOU Careggi, SOD Oculistica, Firenze, Toscana, Italy
| | | |
Collapse
|
46
|
Martínez-de-la-Casa JM, Saenz-Francés F, Morales-Fernandez L, Perucho L, Mendez C, Fernandez-Vidal A, Garcia-Saenz S, Sanchez-Jean R, García-Feijoo J. Clinical outcomes of combined Preserflo Microshunt implantation and cataract surgery in open-angle glaucoma patients. Sci Rep 2021; 11:15600. [PMID: 34341454 PMCID: PMC8329158 DOI: 10.1038/s41598-021-95217-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/22/2021] [Indexed: 02/03/2023] Open
Abstract
To assess the effectiveness and safety of the Preserflo Microshunt (PMS) implantation combined with cataract surgery in open-angle glaucoma (OAG) patients. Retrospective, open-label study conducted on insufficiently controlled OAG patients, who underwent a PMS implant procedure with mitomycin-C 0.2%, either alone or in combination with cataract surgery, and were followed for at least 12 months. Success was defined as an intraocular pressure (IOP) ≤ 18 mmHg and a reduction of at least 20% without (complete) or with (qualified) hypotensive medication. Fifty-eight eyes were included in the study, 35 eyes underwent PMS alone and 23 underwent PMS + Phaco. In the overall study sample, mean IOP was significantly lowered from 21.5 ± 3.3 mmHg at baseline to 14.6 ± 3.5 mmHg at month 12 (p < 0.0001). The IOP was significantly reduced in both groups; p < 0.0001 each, respectively. Ocular hypotensive medication was significantly reduced (p < 0.0001) in both groups. No significant differences were observed in IOP lowering or medication reduction between groups. At month 12, 62.1% eyes were considered as complete success and 82.8% eyes as qualified success. The most common adverse events were device close-to-endothelium, conjunctival fibrosis, and wound leakage. PMS, either alone or in combination with phacoemulsification, may be considered as a valuable option for treating OAG patients.
Collapse
Affiliation(s)
- José M Martínez-de-la-Casa
- Ophthalmology Unit, Department of Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain.
| | - Federico Saenz-Francés
- Ophthalmology Unit, Department of Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain
| | - Laura Morales-Fernandez
- Ophthalmology Unit, Department of Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain
| | - Lucia Perucho
- Ophthalmology Unit, Department of Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain
| | - Carmen Mendez
- Ophthalmology Unit, Department of Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain
| | - Ana Fernandez-Vidal
- Ophthalmology Unit, Department of Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain
| | - Sofía Garcia-Saenz
- Ophthalmology Unit, Department of Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain
| | - Ruben Sanchez-Jean
- Ophthalmology Unit, Department of Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain
| | - Julian García-Feijoo
- Ophthalmology Unit, Department of Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain
| |
Collapse
|
47
|
Beckers HJM, Aptel F, Webers CAB, Bluwol E, Martínez-de-la-Casa JM, García-Feijoó J, Lachkar Y, Méndez-Hernández CD, Riss I, Shao H, Pinchuk L, Angeles R, Sadruddin O, Shaarawy TM. Safety and Effectiveness of the PRESERFLO® MicroShunt in Primary Open-Angle Glaucoma: Results from a 2-Year Multicenter Study. Ophthalmol Glaucoma 2021; 5:195-209. [PMID: 34329772 DOI: 10.1016/j.ogla.2021.07.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the safety and effectiveness of the PRESERFLO® MicroShunt (formerly InnFocus MicroShunt®) in patients with primary open-angle glaucoma (POAG). DESIGN The MicroShunt, a controlled ab-externo glaucoma filtration surgery device, was investigated in a 2-year, multicenter, single-arm study. PARTICIPANTS Eligible patients were aged 18-85 years with POAG inadequately controlled on maximal tolerated medical therapy with intraocular pressure (IOP) ≥18 and ≤35 mmHg and/or where glaucoma progression warranted surgery. INTERVENTION The MicroShunt was implanted as a standalone procedure with adjunctive use of topical Mitomycin C (MMC; 0.2-0.4 mg/mL) for 2-3 minutes. MAIN OUTCOME MEASURES The primary effectiveness outcome was IOP reduction and success (not requiring reoperation or pressure failures [IOP >21 mmHg and <20% reduction in IOP]) at year 1. Additional endpoints at year 2 included IOP reduction, success, glaucoma medications, adverse events (AEs), and reoperations. Results are reported in the overall population, and subgroups of patients receiving 0.2 or 0.4 mg/mL MMC. RESULTS In 81 patients, mean (± standard deviation [SD]) IOP reduced from 21.7±3.4 mmHg at baseline to 14.5±4.6 mmHg at year 1 and 14.1±3.2 mmHg at year 2 (P<0.0001). Overall success (with and without supplemental glaucoma medication use) at year 1 was 74.1%. Mean (± SD) number of medications decreased from 2.1±1.3 at baseline to 0.5±0.9 at year 2 (P<0.0001), 73.8% of patients were medication free. Most common non-serious AEs were increased IOP requiring medication and/or selective laser trabeculoplasty (25.9%) and mild-to-moderate keratitis (11.1%). There were 6 (7.4%) reoperations and 5 (6.2%) needlings by year 2. In an analysis (post-hoc) according to MMC concentration, overall success was 78.1% (0.2 mg/mL) and 74.4% (0.4 mg/mL; P=0.710). In the 0.2 and 0.4 mg/mL MMC groups, 51.9% and 90.3% of patients were medication-free, respectively (P=0.001). There was a trend towards lower IOP and higher medication reduction in the 0.4 mg/mL MMC subgroup. CONCLUSIONS In this study, mean IOP and glaucoma medication reductions were significant and sustained over 2 years post-surgery. No long-term, sight-threatening AEs were reported. Further studies may confirm potential risk/benefits of higher MMC concentration.
Collapse
Affiliation(s)
- Henny J M Beckers
- University Eye Clinic, Maastricht University Medical Center, Maastricht, The Netherlands.
| | | | - Carroll A B Webers
- University Eye Clinic, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - José M Martínez-de-la-Casa
- Departamento de Oftalmologia Universidad Complutense, Hospital Clínico San Carlos, OFTARED, Madrid, Spain
| | - Julián García-Feijoó
- Departamento de Oftalmologia Universidad Complutense, Hospital Clínico San Carlos, OFTARED, Madrid, Spain
| | | | - Carmen D Méndez-Hernández
- Departamento de Oftalmologia Universidad Complutense, Hospital Clínico San Carlos, OFTARED, Madrid, Spain
| | - Isabelle Riss
- Pôle Ophtalmologique de la Clinique Mutualiste, Bordeaux, France
| | - Hui Shao
- Santen Inc., Emeryville, CA, USA
| | | | | | | | | |
Collapse
|
48
|
Luebke J, Boehringer D, Anton A, Daniel M, Reinhard T, Lang S. Trends in Surgical Glaucoma Treatment in Germany Between 2006 and 2018. Clin Epidemiol 2021; 13:581-592. [PMID: 34285592 PMCID: PMC8286102 DOI: 10.2147/clep.s310542] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/13/2021] [Indexed: 01/09/2023] Open
Abstract
Background/Aims Surgical procedures in ophthalmology underlie variations over different time periods and are strongly dependent on the technical process and the invention of innovative surgical techniques. Especially, in glaucoma surgery a lot of surgical devices and techniques have been introduced during the last years. Until now, the use of these newer techniques has not been shown on a robust data basis. We herein present the numbers of different types of glaucoma surgeries performed at German hospitals between 2006 and 2018. Methods and Design The quality reports of hospitals in Germany from 2006 to 2018 were analyzed concerning all procedural codes for glaucoma surgery and intervention. Especially, the change in usage of "classical" and "modern" surgical techniques (MIGS: "minimally invasive glaucoma surgery") or devices was compared. Results The number of glaucoma procedures performed increased by 75% from 27,811 in 2006 to 48,794 in 2018. Absolute numbers of trabeculectomies, goniotomies, ab externo trabeculotomies and to a certain level cyclodestructive procedures decreased during the examined years while use of MIGS has increased in absolute and relative numbers since 2012. From 2015 a strong increase in the usage of XEN implants could be seen. Drainage implants (such as Baerveldt/Ahmed) showed stable absolute numbers over the time period covered. Absolute numbers of laser trabeculoplasty peaked in 2014 and decreased afterwards. Iridotomies and iridectomies increased by 120%/248% over the whole period. Conclusion Our data show a trend towards the modern surgical options and especially MIGS during the recent years. Classical procedures showed a decrease in total numbers emphasized from 2013. These numbers confirm the assumption that modern glaucoma surgery is becoming more and more popular and established in German hospitals.
Collapse
Affiliation(s)
- Jan Luebke
- Eye Center, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Boehringer
- Eye Center, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Moritz Daniel
- Eye Center, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Reinhard
- Eye Center, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefan Lang
- Eye Center, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
49
|
XEN Glaucoma Implant for the Management of Operated Uncontrolled Glaucoma: Results and Complications during a Long-Term Follow-Up. J Ophthalmol 2021; 2021:2321922. [PMID: 34306742 PMCID: PMC8285170 DOI: 10.1155/2021/2321922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/03/2021] [Indexed: 11/26/2022] Open
Abstract
This study aimed to analyze the surgical and refractive outcomes of XEN glaucoma implant (Allergan, an Abbvie company, Irvine, CA, USA), a minimally invasive surgical device for the treatment of operated uncontrolled glaucoma. Eyes that received XEN Gel Stent placement from December 2014 to October 2019 were retrospectively investigated. Intraocular pressure (IOP) change, best-corrected visual acuity (BCVA), change in glaucoma medications, frequency of slit lamp revision procedures, and frequency of secondary glaucoma surgeries were the primary outcomes. Seventy-two eyes of 72 subjects were included in the study: 32 (44%) men and 40 (56%) women. The follow-up period ranged from 1 to 50 months (median, 26.13 months). The mean IOP before surgery was 24.82 ± 8.03 mmHg and decreased to 17.45 ± 5.84 mmHg at the end of the study (mean difference [MD] = −7.48, 95% confidence interval [CI]: −10.04, −4.93; p < 0.001). The mean decrease from baseline was 23%. BCVA before surgery was 0.38 ± 0.30, and that at the end of the follow-up period improved to 0.47 ± 0.37, MD = 0.09, 95% CI: 0.04, 0.13; p < 0.001. Additional procedures (fluorouracil injection and bleb needling) were performed in 11/72 patients (15%). Further glaucoma surgery was necessary for 23.9% of the patients. XEN Gel Stent implantation is both safe and reasonably effective for lowering IOP in operated uncontrolled glaucoma patients.
Collapse
|
50
|
Stoner AM, Capitena Young CE, SooHoo JR, Pantcheva MB, Patnaik JL, Kahook MY, Seibold LK. A Comparison of Clinical Outcomes After XEN Gel Stent and EX-PRESS Glaucoma Drainage Device Implantation. J Glaucoma 2021; 30:481-488. [PMID: 34060508 DOI: 10.1097/ijg.0000000000001823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/03/2021] [Indexed: 11/26/2022]
Abstract
PRECIS Although the XEN stent offers a lower risk of hypotony and choroidal effusions with fewer clinic visits postoperatively, its surgical success rate was inferior to the EX-PRESS shunt. PURPOSE To compare the clinical efficacy and safety outcomes of the XEN stent and EX-PRESS glaucoma drainage device in glaucomatous eyes. MATERIALS AND METHODS One hundred eyes from 88 patients underwent ab interno XEN stent or EX-PRESS shunt implantation (52 XEN and 48 EX-PRESS) for uncontrolled glaucoma at the University of Colorado Eye Center. The primary outcome was surgical success defined as intraocular pressure (IOP) ≥6 and ≤18 mm Hg, without reoperation for uncontrolled glaucoma, loss of light perception, or use of glaucoma medications (complete success). Secondary outcomes were the same requirements allowing for medications (qualified success), mean IOP, medication use, adverse events, and number of postoperative clinic visits in the first 3 months. RESULTS Baseline characteristics including glaucoma type and severity were similar between groups, with the exception of XEN patients having fewer men (17% vs. 46%), older patients (median age, 78 vs. 68), and a higher percentage of white patients (89% vs. 69%). Adjusted hazard ratio of failure of XEN relative to EX-PRESS was 3.94 (95% confidence interval, 1.73-9.00, P=0.001) for complete success and 1.61 (95% confidence interval, 0.40-6.38, P=0.501) for qualified success. There were significantly fewer postoperative clinic visits during the first 3 months in the XEN group (5.3 vs. 9.1 visits, P<0.001). The incidence of serous choroidal effusions and hypotony was significantly less after XEN compared with EX-PRESS (1 vs. 9, P=0.02 and 15 vs. 25, P=0.023, respectively). Three XEN stents (5.8%) required removal. CONCLUSIONS In this population, although the XEN stent offers a better safety profile and fewer postoperative clinic visits, complete surgical success was inferior to the EX-PRESS shunt.
Collapse
Affiliation(s)
- Ari M Stoner
- Indiana University School of Medicine, Indianapolis, IN
| | | | - Jeffrey R SooHoo
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
| | - Mina B Pantcheva
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
| | - Malik Y Kahook
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
| | - Leonard K Seibold
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
| |
Collapse
|