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Carassa RG, Corsini G, Triolo G. Long-term effectiveness and safety of XEN45 in open-angle glaucoma patients. Int Ophthalmol 2024; 44:310. [PMID: 38960998 DOI: 10.1007/s10792-024-03234-2] [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: 11/26/2023] [Accepted: 06/19/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND To investigate the long-term effectiveness and safety of XEN45 implant, either alone or in combination with phacoemulsification, in eyes with open-angle glaucoma (OAG). METHODS Retrospective and single center study conducted on consecutive OAG patients who underwent a XEN45 implant between February-2017 and December-2021. The primary endpoint was the mean intraocular pressure (IOP) lowering from preoperative values. Surgical success was defined as an IOP-lowering from preoperative values ≥ 20% and an IOP absolute value between 6 and 13 mm Hg, without (Complete-success) or with (Qualified-success) antiglaucoma medications. RESULTS A total of 158 eyes (34 (21.5%) eyes XEN-solo and 124 (78.5%) XEN + Phaco) were included. The median follow-up time was 28.5 months. In the overall study population, the mean preoperative IOP was significantly lowered from 19.4 ± 6.5 mm Hg to 12.4 ± 5.0 mm Hg. The mean preoperative (95% confidence interval) IOP was significantly lowered from 21.3 (19.3-23.2) mm Hg and 18.8 (17.7-20.0) mm Hg to 12.0 (10.4-13.6) mm Hg and 12.5 (11.6-13.5) mm Hg in the XEN-Solo and XEN + Phaco groups, respectively (p < 0.0001 each, respectively). The mean number of ocular-hypotensive medications was significantly reduced in the overall study sample (from 3.4 ± 0.9 to 0.9 ± 1.3, p < 0.0001), XEN-Solo (from 3.5 ± 1.1 to 0.6 ± 1.0, p < 0.0001, and XEN + Phaco (from 3.4 ± 1.1 to 0.9 ± 1.3, p < 0.0001) groups. Eighty-four (53.2%) eyes were categorized as success, with 49 (58.3%) classified as complete success. Eighty-one (51.3%) eyes underwent needling and 15 (9.5%) eyes required an additional surgical procedure. One (0.6%) eye had endophthalmitis. CONCLUSION XEN implant, either alone or in combination with phacoemulsification significantly lowered IOP and reduced the need of ocular-hypotensive medication, while maintaining a good safety profile.
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Affiliation(s)
- Roberto G Carassa
- Centro Italiano Glaucoma, Viale Tunisia, 45, 20124, Milan, MI, Italy.
| | - Gabriele Corsini
- Centro Italiano Glaucoma, Viale Tunisia, 45, 20124, Milan, MI, Italy
- ASST Settelaghi, Di Circolo Hospital and Macchi Foundation, Ophthalmology Clinic, Varese, Italy
| | - Giacinto Triolo
- Centro Italiano Glaucoma, Viale Tunisia, 45, 20124, Milan, MI, Italy
- Department of Surgical Sciences, University Eye Clinic, IRCCS Policlinico San Matteo, Pavia, Italy
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Lee SS, Nagar S, Rajagopalan L, Orilla W, Csaky KG, Almazan A, Yang L, Robinson MR. Using a Novel, Subconjunctival, Sustained-Release Mitomycin C Formulation in a Rabbit Model of Filtration Surgery with Gel Stent Implantation. J Ocul Pharmacol Ther 2024; 40:297-308. [PMID: 38687355 PMCID: PMC11296147 DOI: 10.1089/jop.2023.0100] [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: 07/27/2023] [Accepted: 02/28/2024] [Indexed: 05/02/2024] Open
Abstract
Purpose: To investigate gel stent implantation with and without intraoperative sustained-release mitomycin C (MMC SR) in a rabbit model for gel stent implantation, and to examine aqueous humor outflow (AHO) postimplantation. Methods: Four groups of rabbits were included. Group 1 was untreated (control). Groups 2, 3, and 4 received the gel stent without MMC, with MMC solution (subconjunctival injection), and with MMC SR (subconjunctival injection), respectively. Intraocular pressure (IOP) and AHO were assessed via tonometry and indocyanine green-based angiography, respectively. The main efficacy measure was change in IOP from baseline. Results: Following gel stent implantation, Groups 2, 3, and 4 maintained ≥20% IOP reduction (response) for a median duration of 1 week, 6.5 weeks, and 30 weeks, respectively. Angiography showed normal aqueous humor drainage (Group 1) beginning at the perilimbal trabecular plexus and continuing posteriorly to episcleral outflow vessels. Following implantation, drainage occurred preferentially and directly into the subconjunctival bleb. Conclusions: Gel stent implantation with MMC SR was most effective in achieving sustained, long-term IOP reduction in the rabbit model, compared with implantation with or without MMC solution. Bleb presence and the postimplantation aqueous angiography results indicated redirection of the AHO to the subconjunctival vasculature and presumed lymphatics, suggesting efficient glaucoma filtration to lower IOP in this model. This rabbit model and aqueous angiography may help refine understanding of the mechanism of action of minimally invasive glaucoma surgeries and ultimately translate to improved surgical devices and procedures for patients with glaucoma.
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Affiliation(s)
- Susan S. Lee
- Allergan, an AbbVie company, Irvine, California, USA
| | - Saumya Nagar
- Allergan, an AbbVie company, Irvine, California, USA
| | | | | | - Karl G. Csaky
- Retina Foundation of the Southwest, Dallas, Texas, USA
| | | | - Liuqing Yang
- Allergan, an AbbVie company, Irvine, California, USA
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Papazoglou A, Höhn R, Schawkat M, Tappeiner C, Iliev M, Gugleta K, Saletta G, Wiencierz A, Wagels B, Todorova MG, Krzyzanowska I, Töteberg-Harms M, Tschopp M. Swiss Multicenter Ab Interno XEN45 Gel Stent Study: 2-Year Real-World Data. Ophthalmol Ther 2024; 13:1513-1525. [PMID: 38581605 PMCID: PMC11109057 DOI: 10.1007/s40123-024-00917-y] [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: 01/11/2024] [Accepted: 02/21/2024] [Indexed: 04/08/2024] Open
Abstract
INTRODUCTION The aim of this study was to investigate the 2-year postoperative efficacy of the XEN45 Gel Stent by evaluating the reduction of intraocular pressure (IOP) and the need for eye pressure-lowering medications in a multicenter setting in Switzerland. METHODS Patients with various types of glaucoma who received a XEN45 Gel Stent with or without combined phacoemulsification cataract surgery at five hospitals in Switzerland were retrospectively enrolled. Pre- and postoperative IOP, the number of antiglaucoma medications, and the need of subsequent interventions to control IOP were assessed. The success rate was defined as a ≥ 20% reduction of IOP 2 years postoperatively without the need for subsequent glaucoma surgery. RESULTS A total of 345 eyes were included: 44.3% with primary open-angle, 42.0% pseudoexfoliation, and 13.7% with other types of glaucoma. Of these, 206 patients were followed for 2 years. Preoperatively, the mean IOP was 26.3 ± 8.9 mmHg and the mean number of antiglaucoma medications administered was 3.0 ± 1.3. Two years postoperatively, the success rate was 66.0% (95% confidence interval 59.3-72.1%), the IOP had dropped by 43.8% to 14.8 ± 5.7 mmHg, and the number of medications was reduced by a mean of 2.0 ± 1.7 per day. Postoperative complications and the need for interventions remained low. CONCLUSION The XEN45 Gel Stent successfully reduced IOP and the number of antiglaucoma drugs in most patients at 2 years postoperatively.
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Affiliation(s)
- Anthia Papazoglou
- Department of Ophthalmology, Cantonal Hospital Aarau, Aarau, Switzerland.
- Medical Faculty, University of Zurich, Zurich, Switzerland.
| | - René Höhn
- Department of Ophthalmology, University Hospital Bern, Bern, Switzerland
- Eyeparc Eyeclinic, Bern, Switzerland
| | - Megir Schawkat
- Department of Ophthalmology, University Hospital Bern, Bern, Switzerland
| | - Christoph Tappeiner
- Department of Ophthalmology, University Hospital Bern, Bern, Switzerland
- Department of Ophthalmology, Pallas Kliniken, Olten, Switzerland
- Medical Faculty, University of Bern, Bern, Switzerland
- Department of Ophthalmology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Milko Iliev
- Department of Ophthalmology, University Hospital Bern, Bern, Switzerland
- Medical Faculty, University of Bern, Bern, Switzerland
| | - Konstantin Gugleta
- Department of Ophthalmology, University of Basel and University Hospital, Basel, Switzerland
| | - Giulia Saletta
- Department of Ophthalmology, University of Basel and University Hospital, Basel, Switzerland
| | - Andrea Wiencierz
- Department of Clinical Research, University of Basel and University Hospital, Basel, Switzerland
| | - Barbara Wagels
- Department of Ophthalmology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Margarita G Todorova
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Department of Ophthalmology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Iwona Krzyzanowska
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Marc Töteberg-Harms
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Markus Tschopp
- Department of Ophthalmology, Cantonal Hospital Aarau, Aarau, Switzerland.
- Medical Faculty, University of Bern, Bern, Switzerland.
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Kiessling D, Rennings C, Hild M, Lappas A, Dietlein TS, Roessler GF, Widder RA. Combined versus standalone XEN45 Gel Stent implantation in either phakic or pseudophakic patients: a case-matched study. Graefes Arch Clin Exp Ophthalmol 2024; 262:1253-1262. [PMID: 37950751 PMCID: PMC10995041 DOI: 10.1007/s00417-023-06283-y] [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: 07/11/2023] [Revised: 09/15/2023] [Accepted: 10/12/2023] [Indexed: 11/13/2023] Open
Abstract
PURPOSE To determine differing outcomes among either phakic or pseudophakic patients who received standalone XEN45 Gel Stent (Allergan, an AbbVie Company, CA, USA) implantation and patients who underwent combined surgery with phacoemulsification. METHODS This retrospective single-center study involved 180 eyes of 180 participants who underwent XEN45 Gel Stent implantation, of which 60 eyes received combined surgery with phacoemulsification (combined group). Standalone stent implantation was performed on 60 phakic (phakic group) and on 60 pseudophakic eyes (pseudophakic group). The groups were matched in a ratio of 1:1:1 based on multiple criteria. Successful surgery was defined by three scores: IOP at the longest follow-up of < 21 mmHg (Score A) or < 18 mmHg (Score B) and an IOP reduction > 20% or IOP ≤ 15 mmHg and an IOP reduction ≥ 40% (Score C). In all scores, one open conjunctival revision was allowed, and additional repeat surgery was considered a failure. RESULTS After an average follow-up time interval of 20.6 ± 12.6 months, there was a mean IOP-reduction by 37% among the entire cohort. Comparative analysis between the three groups did not show significant differences regarding postoperative IOP, postoperative medication score, side effects, revision rate, repeat surgery rate or success rate. A dysfunctional stent was detected in eight eyes (4%) during open conjunctival revision in 76 eyes. CONCLUSION The clinical endpoints investigated did not differ significantly among either phakic or pseudophakic patients who received standalone stent implantation and patients who underwent combined surgery. However mean latency between primary stent implantation and first revision surgery after combined surgery was markedly shorter.
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Affiliation(s)
- David Kiessling
- Department of Ophthalmology, St. Martinus-Krankenhaus Düsseldorf, Gladbacher Str. 26, 40219, Düsseldorf, Germany
| | - Corinna Rennings
- Department of Ophthalmology, St. Martinus-Krankenhaus Düsseldorf, Gladbacher Str. 26, 40219, Düsseldorf, Germany
| | - Matthias Hild
- Department of Ophthalmology, St. Martinus-Krankenhaus Düsseldorf, Gladbacher Str. 26, 40219, Düsseldorf, Germany
| | - Alexandra Lappas
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | | | - Gernot Franz Roessler
- Department of Ophthalmology, St. Martinus-Krankenhaus Düsseldorf, Gladbacher Str. 26, 40219, Düsseldorf, Germany
- Department of Ophthalmology, RWTH Aachen, Aachen, Germany
| | - Randolf Alexander Widder
- Department of Ophthalmology, St. Martinus-Krankenhaus Düsseldorf, Gladbacher Str. 26, 40219, Düsseldorf, Germany.
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.
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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.
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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
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Busch T, Skiljic D, Rudolph T, Bergström A, Zetterberg M. Four-Year Outcome of XEN 45 Gel Stent Implantation in a Swedish Population. Clin Ophthalmol 2023; 17:1897-1910. [PMID: 37425030 PMCID: PMC10328829 DOI: 10.2147/opth.s412400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose To report the long-time success rate of XEN 45 gel stent implantation in a Scandinavian population. Patients and Methods This was a retrospective single-center analysis of all patients undergoing XEN 45 stent surgery between December 2015 and May 2017. The main outcome was success rate according to several definitions of success. Subgroup analysis was performed. Secondary outcomes were change in intraocular pressure (IOP) and number of IOP-lowering agents. Need for secondary glaucoma surgery, needling rate and complications were recorded. Results A total of 103 eyes could be evaluated after four years. Mean age was 70.6 years. Primary open-angle glaucoma (POAG) accounted for 46.6% and exfoliative glaucoma (PEXG) for 39.8%. Mean IOP dropped from 24.0 to 15.9 mmHg (p<0.001) and IOP-lowering agents from 3.5 to 1.5 (p<0.001). The success rate with individual target pressures after four years was 43.7%. Secondary glaucoma surgery was performed in 45 (43.7%) of cases. Combined cases (n=12) were not statistically different to stand-alone procedures (p=0.28). No difference between PEXG and POAG could be detected (p=0.44). During the learning curve, stent misplacement was common and resulted in worse outcome for less experienced surgeons. Conclusion The overall success rate of XEN 45 gel stent surgery in the present cohort is relatively low in a long-time follow-up under the given circumstances if all initial patients are included to follow-up. The influence of the surgeon's learning curve is obvious, and improvement in success can be expected when used by experienced and high-volume surgeons. No significant differences were found in PEXG compared to POAG or in XEN surgery combined with cataract surgery compared to stand-alone.
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Affiliation(s)
- Tobias Busch
- Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Region Västra Götaland, Sweden
| | - Dragana Skiljic
- Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Region Västra Götaland, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thiemo Rudolph
- Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Region Västra Götaland, Sweden
| | - Anders Bergström
- Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Region Västra Götaland, Sweden
- Department of Ophthalmology, Skåne University Hospital, Lund, Sweden
| | - Madeleine Zetterberg
- Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Region Västra Götaland, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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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.
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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.
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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
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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.
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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
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Bui TT, Rosdahl JA. Systematic Review of MIGS and Non-Penetrating Glaucoma Procedures for Uveitic Glaucoma. Semin Ophthalmol 2022; 37:830-838. [PMID: 35894683 DOI: 10.1080/08820538.2022.2102927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Minimally invasive glaucoma surgeries (MIGS) and non-penetrating glaucoma procedures have changed the surgical management of glaucoma in recent years and are being explored in the management of uveitic glaucoma. Deep sclerectomy, Xen45 gel stent, gonioscopy-assisted transluminal trabeculotomy (GATT), trabectome, and canaloplasty are described in the literature as alternative surgeries that may work for uveitic glaucoma. While most of the published studies are retrospective case series, the results suggest success even in refractory cases and with less inflammation than more traditional surgeries.
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Affiliation(s)
- Trung Thanh Bui
- Philadelphia College of Osteopathic Medicine, Moultrie, GA, USA
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Pahljina C, Sarny S, Hoeflechner L, Falb T, Schliessleder G, Lindner M, Ivastinovic D, Mansouri K, Lindner E. Glaucoma Medication and Quality of Life after Phacoemulsification Combined with a Xen Gel Stent. J Clin Med 2022; 11:jcm11123450. [PMID: 35743517 PMCID: PMC9225126 DOI: 10.3390/jcm11123450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/30/2022] [Accepted: 06/12/2022] [Indexed: 02/06/2023] Open
Abstract
Glaucoma has a significant impact on quality of life. Here, we aimed to evaluate the influence of a reduction in glaucoma medications on quality of life and patient satisfaction after phacoemulsification combined with the Xen gel stent. We carried out a cross-sectional survey of patients who underwent phacoemulsification with the Xen gel stent at the Medical University of Graz, Austria. Quality of life was assessed using the German version of the Glaucoma Symptoms Scale (GSS)—questionnaire. Patients were also asked whether the operation reduced glaucoma medications and to indicate their overall satisfaction from 1 (totally discontented) up to 10 (totally contented). Questionnaires of 80 patients were evaluated. A total of 36 patients (45.0%) reported a reduction in glaucoma medications. Three items of the GSS were significantly better in patients who needed fewer glaucoma medications after the operation (“hard to see in daylight”, 75.0 ± 31.1 vs. 57.7 ± 39.1, p = 0.035; “hard to see in dark places”, 81.1 ± 28.7 vs. 54.9 ± 41.2, p = 0.002; and “halos around lights”, 88.3 ± 25.9 vs. 68.8 ± 38.6, p = 0.002). Patient satisfaction was significantly higher when the procedure led to a reduction in glaucoma medication (8.3 ± 2.0 vs. 6.8 ± 3.1; p = 0.034). The reported quality of life and patient satisfaction were significantly better when phacoemulsification with the Xen gel stent reduced the number of glaucoma medications needed.
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Affiliation(s)
- Christian Pahljina
- Department of Ophthalmology, Medical University Graz, 8036 Graz, Austria; (C.P.); (S.S.); (L.H.); (T.F.); (G.S.); (D.I.)
| | - Stephanie Sarny
- Department of Ophthalmology, Medical University Graz, 8036 Graz, Austria; (C.P.); (S.S.); (L.H.); (T.F.); (G.S.); (D.I.)
| | - Lukas Hoeflechner
- Department of Ophthalmology, Medical University Graz, 8036 Graz, Austria; (C.P.); (S.S.); (L.H.); (T.F.); (G.S.); (D.I.)
| | - Thomas Falb
- Department of Ophthalmology, Medical University Graz, 8036 Graz, Austria; (C.P.); (S.S.); (L.H.); (T.F.); (G.S.); (D.I.)
| | - Gernot Schliessleder
- Department of Ophthalmology, Medical University Graz, 8036 Graz, Austria; (C.P.); (S.S.); (L.H.); (T.F.); (G.S.); (D.I.)
| | - Marlene Lindner
- Department of Dentistry, Medical University Graz, 8036 Graz, Austria;
| | - Domagoj Ivastinovic
- Department of Ophthalmology, Medical University Graz, 8036 Graz, Austria; (C.P.); (S.S.); (L.H.); (T.F.); (G.S.); (D.I.)
| | - Kaweh Mansouri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, 1006 Lausanne, Switzerland;
| | - Ewald Lindner
- Department of Ophthalmology, Medical University Graz, 8036 Graz, Austria; (C.P.); (S.S.); (L.H.); (T.F.); (G.S.); (D.I.)
- Correspondence:
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12
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Saletta G, Alexoudis A, Gkatzioufas Z, Grieshaber M, Papazoglou A, Tschopp M, Töteberg M, Gugleta K. Retrospective Analysis of 12 Months Glaucoma Implant Efficacy: XEN45 and PreserFlo Microshunt. Klin Monbl Augenheilkd 2022; 239:429-434. [PMID: 35472784 DOI: 10.1055/a-1766-6444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Several new implant devices have recently been introduced to glaucoma surgery using various techniques for reducing intraocular pressure (IOP). Two implants introduced during the past couple of years, XEN45 and PreserFlo Microshunt, are both designed to control subconjunctival filtration. There are two Swiss multicenter studies that collected the data retrospectively to analyze the efficacy and safety of these two devices separately. In this study, we report the analysis of the combined data subset from the University Hospital of Basel. SUBJECTS AND METHODS The XEN45 implantation technique was introduced to Basel University Hospital in 2016 and PreserFlo Microshunt in 2018. Sixty operated patients, thirty in each group, were operated on by one surgeon, clinically followed up, and their data retrospectively analyzed from medical records. Only standalone procedures, without combined phacoemulsification, were considered in this analysis; the lens status, however, was neither an inclusion nor an exclusion criterion. Further inclusion criteria were the diagnosis of open-angle glaucoma, no previous glaucoma surgery, other than laser trabeculoplasty, and complete medical records during the 12 months of follow-up. IOP reduction during a 12-month postoperative period was the primary outcome measure as well as the number of IOP reducing drugs. The number of subsequent surgical interventions and complications/adverse events are descriptively reported. RESULTS Patient age, gender, ophthalmological diagnosis, and initial preoperative IOP were well balanced between the two groups. Postoperative IOP course was comparable between the two methods for the first 12 months. IOP measurements were taken preoperatively and then on the first postop day, week 1, month 1, and months 3, 6, and 12 for the PreserFlo Microshunt vs. XEN45 (mmHg): 23.6 vs. 24.9, 9.0 vs. 8.9, 11.4 vs. 10.6, 13.0 vs.18.3, 16.8 vs.15.1, 15.9 vs.15.0, and 15.4 vs.14.5, respectively. IOP reducing medications were also comparable between the two groups. The study showed that subsequent interventions were more frequent in the XEN45 (13) than in the PreserFlo Microshunt group (7). CONCLUSION Both methods demonstrate satisfactory IOP control within a 12-month postoperative period with practically no serious adverse events/complications, but with relatively high numbers of subsequent interventions (needlings), particularly in the XEN45 group.
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Affiliation(s)
- Giulia Saletta
- Department of Ophthalmology, Universitätsspital Basel, Basel, Switzerland
| | - Antonios Alexoudis
- Department of Ophthalmology, Universitätsspital Basel, Basel, Switzerland.,Department of Ophthalmology, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Zisis Gkatzioufas
- Department of Ophthalmology, Universitätsspital Basel, Basel, Switzerland
| | | | - Anthia Papazoglou
- Department of Ophthalmology, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Markus Tschopp
- Department of Ophthalmology, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Marc Töteberg
- Department of Ophthalmology, Universitätsspital Zürich, Zürich, Switzerland
| | - Konstantin Gugleta
- Department of Ophthalmology, Universitätsspital Basel, Basel, Switzerland
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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.
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Predictability of success and open conjunctival revision rates in the subsequent eye after XEN45 Gel Stent implantation according to lens status. Graefes Arch Clin Exp Ophthalmol 2022; 260:2639-2647. [PMID: 35113249 PMCID: PMC9325854 DOI: 10.1007/s00417-022-05569-x] [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: 10/13/2021] [Revised: 12/10/2021] [Accepted: 01/14/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To determine the predictability of success and the risk of open conjunctival revision in the subsequent eye after XEN45 Gel Stent implantation according to lens status. METHODS This was a retrospective single-centre study involving 132 eyes of 66 participants who had undergone intraocular pressure (IOP)-lowering XEN45 Gel Stent implantation, either as a standalone procedure in phakic and pseudophakic eyes or in combination with phacoemulsification. Successful surgery was defined by three scores: IOP at follow-up < 21 mmHg (score A) or < 18 mmHg (score B) and an IOP reduction > 20% or IOP ≤ 15 mmHg and an IOP reduction ≥ 40% (score C). In all scores, one open conjunctival revision was allowed, and additional repeat surgery was considered a failure. The predictability of success and revision rate depending on the outcome of the first eye were calculated using Bayes' theorem. RESULTS IOP-lowering did not differ significantly between the first and second eyes. Success rates of standalone surgery in the second eye after successful surgery in the first eye significantly exceed rates after prior failure. For the combined procedure, the rates did not differ significantly. For score A, we determined a 76.6% chance of success following a prior success and a 57.9% chance, if prior surgery failed. The corresponding probabilities were 75% and 59.1% for score B, while 66.7% and 15.7% for score C, respectively. We calculated a 60% risk for revision surgery in the standalone phakic group. If the first eye was not revised, the risk of revision in the subsequent eye was 20%. The corresponding risks were 72.7% and 5% for the standalone procedure in pseudophakic patients and 38.4% and 41.7% for the combined procedure, respectively. CONCLUSION The results of our study offer a tool to predict the outcome of subsequent eye surgeries based on either the outcome in the initial eye and the type of surgery performed, owing to the high predictive potential.
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Kiessling D, Rennings C, Hild M, Lappas A, Dietlein TS, Roessler GF, Widder RA. Impact of failed ab-interno trabeculectomy (trabectome) on subsequent XEN45 gel stent implantation in pseudophakic eyes. Int Ophthalmol 2021; 41:4047-4053. [PMID: 34365554 PMCID: PMC8572817 DOI: 10.1007/s10792-021-01977-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the impact of failed ab-interno trabeculectomy on the postoperative outcome of subsequent XEN45 gel stent (Allergan, CA, USA) implantation in pseudophakic eyes. METHODS In this retrospective single-center study, we included 60 pseudophakic eyes from 60 participants who underwent XEN45 gel stent implantation. Thirty eyes each underwent primary stent implantation (control group) or had previously undergone a failed ab-interno trabeculectomy (trabectome group). The groups were matched at a 1:1 ratio based on the following criteria: preoperative and maximum Intraocular pressure (IOP), preoperative medication score, cup/disk-ratio, follow-up time, best-corrected visual acuity at baseline, age, and the proportion of patients classified as primary open angle glaucoma or exfoliation glaucoma. We defined a successful surgery by the following three scores: an IOP reduction > 20% and IOP at the longest follow-up < 21 mmHg (Score A) or < 18 mmHg (Score B) or IOP ≤ 15 mmHg and an IOP reduction ≥ 40% (Score C). One open conjunctival revision was allowed in all scores, and a repeat surgery was considered a failure. RESULTS Following an average follow-up period of 22 ± 12 months, we observed a mean IOP reduction of 38%, from 23.5 ± 5.2-14.5 ± 5.0 mmHg. Comparative analyses between the groups did not reveal a significant difference in the postoperative IOP, postoperative medication score, side effects, revision rate, repeat surgery rate, or success rate. CONCLUSIONS Trabectome is a viable first-line procedure for medically uncontrolled glaucoma before filtering ab-interno microstent surgery is considered.
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Affiliation(s)
- D Kiessling
- Department of Ophthalmology, St. Martinus-Krankenhaus, Gladbacher Str.26, 40219, Düsseldorf, Germany
| | - C Rennings
- Department of Ophthalmology, St. Martinus-Krankenhaus, Gladbacher Str.26, 40219, Düsseldorf, Germany
| | - M Hild
- Department of Ophthalmology, St. Martinus-Krankenhaus, Gladbacher Str.26, 40219, Düsseldorf, Germany
| | - A Lappas
- Department of Ophthalmology, University Hospital of Cologne, Kerpener Str 62, 50935, Cologne, Germany
| | - T S Dietlein
- Department of Ophthalmology, University Hospital of Cologne, Kerpener Str 62, 50935, Cologne, Germany
| | - G F Roessler
- Department of Ophthalmology, St. Martinus-Krankenhaus, Gladbacher Str.26, 40219, Düsseldorf, Germany.,Department of Ophthalmology, RWTH Aachen University, Pauwelstr. 30, 52074, Aachen, Germany
| | - Randolf Alexander Widder
- Department of Ophthalmology, St. Martinus-Krankenhaus, Gladbacher Str.26, 40219, Düsseldorf, Germany. .,Department of Ophthalmology, University Hospital of Cologne, Kerpener Str 62, 50935, Cologne, Germany.
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