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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.
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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
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Cheema AA, Cheema HR. The Evolution and Current Landscape of Minimally Invasive Glaucoma Surgeries: A Review. Cureus 2024; 16:e52183. [PMID: 38264176 PMCID: PMC10804217 DOI: 10.7759/cureus.52183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2024] [Indexed: 01/25/2024] Open
Abstract
This review examines the evolution, current status, and future potential of minimally invasive glaucoma surgeries (MIGS), a significant advancement in the treatment of glaucoma, a leading cause of irreversible blindness. MIGS offer a less invasive alternative to traditional glaucoma surgeries, primarily aimed at reducing intraocular pressure, minimizing tissue trauma, and providing a safer profile. With the emergence of devices such as the Trabectome, iStent, and others, MIGS have expanded the surgical toolkit, allowing personalized, patient-centered care. Despite their advantages, MIGS face challenges such as efficacy in severe cases, long-term data, and accessibility. Ongoing research and technological innovations continue to refine their capabilities and applications, promising to further transform glaucoma management and patient outcomes. This paper provides an in-depth analysis of MIGS, reflecting on their impact and contemplating future directions in this dynamically evolving field.
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