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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.
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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
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Multicenter case series of standalone XEN implant vs. combination with phacoemulsification in Turkish patients. Int Ophthalmol 2021; 41:3371-3379. [PMID: 34050406 DOI: 10.1007/s10792-021-01899-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
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.
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Theillac V, Blumen-Ohana E, Akesbi J, Hamard P, Sellam A, Brasnu E, Baudouin C, Labbe A, Nordmann JP. Cataract and glaucoma combined surgery: XEN® gel stent versus nonpenetrating deep sclerectomy, a pilot study. BMC Ophthalmol 2020; 20:231. [PMID: 32546150 PMCID: PMC7298949 DOI: 10.1186/s12886-020-01492-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 06/01/2020] [Indexed: 11/22/2022] Open
Abstract
Background To compare the efficacy of phacoemulsification (PKE) combined with nonpenetrating deep sclerectomy (NPDS) with mitomycin C (MMC) versus XEN® gel stent with MMC. Methods In this nonrandomized, retrospective, comparative, single-center pilot study, 105 consecutive eyes of 75 patients with uncontrolled primary open-angle glaucoma (POAG) and cataract who underwent PKE combined with either XEN implantation (n = 47) or NPDS (n = 58) between May 2013 and November 2018 were included. The primary outcome was complete success at 9 months, which was defined as intraocular pressure (IOP) ≤18, 15 or 12 mmHg without treatment; qualified success was IOP ≤18, 15 or 12 mmHg with antiglaucoma medications. Secondary outcome measures included the number of antiglaucoma medications, visual acuity (VA), and postoperative adverse events. Results Using the 18 mmHg threshold, complete or qualified success was achieved in 69.6 and 89.1% in the PKE + XEN group, and 63.8 and 89.7% in the PKE + NPDS group (p = .54 and p = .93), respectively, at 9 months. The mean IOP decreased from 20.8 ± 6.8 mmHg to 16.2 ± 2.8 mmHg in the PKE + XEN group (p < .001, 18.9% mean drop), and from 21.5 ± 8.9 mmHg to 14.9 ± 3.9 mmHg in the PKE + NPDS group (p < .001, 25.6% mean drop). Best-corrected VA significantly improved (p < .001) in both groups. The mean number of antiglaucoma medications was significantly reduced from 2.66 ± 1.1 to 0.49 ± 1.0 in the PKE + XEN group (p < .001) and from 2.93 ± 0.9 to 0.69 ± 1.2 in the PKE + NPDS group (p < .001). Conclusions The XEN stent combined with PKE seemed to be as effective and safe as PKE + NPDS at 9 months in this pilot study.
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Affiliation(s)
- Vincent Theillac
- Department of Ophthalmology 2, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, University Paris Descartes, 28 rue de Charenton, 75012, Paris, France.
| | - Esther Blumen-Ohana
- Department of Ophthalmology 2, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, University Paris Descartes, 28 rue de Charenton, 75012, Paris, France
| | - Jad Akesbi
- Department of Ophthalmology 2, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, University Paris Descartes, 28 rue de Charenton, 75012, Paris, France
| | - Pascale Hamard
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, Paris and Versailles Saint-Quentin-en-Yvelines University, Versailles, France
| | - Alexandre Sellam
- Department of Ophthalmology 2, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, University Paris Descartes, 28 rue de Charenton, 75012, Paris, France
| | - Emmanuelle Brasnu
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, Paris and Versailles Saint-Quentin-en-Yvelines University, Versailles, France
| | - Christophe Baudouin
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, Paris and Versailles Saint-Quentin-en-Yvelines University, Versailles, France.,INSERM U968; UPMC Univ Paris 06, UMR_S968, Institut de la Vision; CNRS, UMR 7210; CHNO des Quinze-Vingts, INSERM-DHOS CIC 503, Paris, France
| | - Antoine Labbe
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, Paris and Versailles Saint-Quentin-en-Yvelines University, Versailles, France.,INSERM U968; UPMC Univ Paris 06, UMR_S968, Institut de la Vision; CNRS, UMR 7210; CHNO des Quinze-Vingts, INSERM-DHOS CIC 503, Paris, France
| | - Jean-Philippe Nordmann
- Department of Ophthalmology 2, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, University Paris Descartes, 28 rue de Charenton, 75012, Paris, France
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Comparison of the 1-year postoperative results of phacoemulsification-trabeculectomy and phacoemulsification-ExPRESS miniature shunt combined surgeries. Int Ophthalmol 2020; 40:1517-1529. [PMID: 32100264 DOI: 10.1007/s10792-020-01321-8] [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: 10/31/2019] [Accepted: 02/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVE This study aimed to compare the 1-year postoperative phacoemulsification-trabeculectomy (P-Trab) and phacoemulsification-ExPRESS® (P-200 model) miniature shunt (P-ExPRESS) combined surgeries. MATERIALS AND METHODS This retrospective, comparative clinical study investigated 41 eyes of 41 patients diagnosed with open-angle glaucoma and cataract. Of these, 21 eyes underwent P-Trab surgery and 20 eyes underwent P-ExPRESS surgery. The 1-year follow-up results, including intraocular pressure (IOP), visual acuity (VA), medications, and complications, were reviewed and compared. A 5 ≤ IOP ≤ 18 mmHg or 30% reduction from baseline was defined as Qualified Success (QS-1), and target IOP without medication was defined as Complete Success (CS-1). A 5 ≤ IOP ≤ 15 mmHg or 40% reduction from baseline was defined as Qualified Success (QS-2), and target IOP without medication was defined as Complete Success (CS-2). RESULTS The mean follow-up time was 16 months (12-26 months). Results after the twelfth month for P-Trab versus P-ExPRESS are: CS-1: 42.8% versus 60.0% (P = 0.354); QS-1: 86.7% versus 95% (P = 0.606); CS-2:33.3% versus 40% (P = 0.751); QS-2: 66.6% versus 75% (P = 0.733). Kaplan-Meier survival analysis was not statistically significant between two groups for both QS-1, CS-1 and QS-2, CS-2 (P = 0.329 vs P = 0.365, P = 0.765 vs P = 0.789, respectively). Pre-op mean IOP was: 33.19 ± 8.7 versus 34.55 ± 11.3 mmHg; post-op mean IOP was: 15.19 ± 3.07 versus 15.30 ± 3.32 mmHg (P = 0.913); pre-op mean VA was: 1.17 ± 1.04 versus 1.15 ± 1.07 logMAR; and post-op mean VA was: 0.61 ± 0.80 versus 0.66 ± 0.99 logMAR (P = 0.869). The pre-op mean number of antiglaucomatous medications was 3.76 ± 0.53 versus 3.30 ± 1.45, and the post-op results were 1.52 ± 1.53 versus 0.85 ± 1.26 (P = 0.135). Comparing the pre-op and post-op values, both types of surgeries were equally effective (P = 0.00). Surgical failure was 14.2% (3/21) versus 5% (1/20), and the incidence ratios of significant complications were: 47% (10/21) versus 10% (2/20) and P-Trab versus P-ExPRESS, respectively (P = 0.015). CONCLUSION The 1-year postoperative results suggest that P-ExPRESS is as effective as P-Trab, with fewer complications.
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Marcos Parra MT, Salinas López JA, López Grau NS, Ceausescu AM, Pérez Santonja JJ. XEN implant device versus trabeculectomy, either alone or in combination with phacoemulsification, in open-angle glaucoma patients. Graefes Arch Clin Exp Ophthalmol 2019; 257:1741-1750. [PMID: 31093766 DOI: 10.1007/s00417-019-04341-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/23/2019] [Accepted: 04/26/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To compare the efficacy and safety of the XEN45 implant with that of trabeculectomy (TRAB), either alone or in combination with phacoemulsification (PHACO), in patients with open-angle glaucoma (OAG). METHODS Retrospective, single-center and comparative study conducted on OAG patients. Patients were divided into four groups: group 1 (XEN alone); group 2 (XEN+PHACO); group 3 (TRAB alone); group 4 (TRAB+PHACO). For statistical purposes, groups 1 and 2 were combined (XEN implant), while groups 3 and 4 were also combined (TRAB surgery). The main outcome measure was intraocular pressure (IOP). RESULTS Ninety-one patients (121 eyes; 65 XEN and 56 TRAB) were included. IOP reduction was - 6.7 (- 10.4 to - 3.0) mmHg, p = 0.0013; - 3.5 (- 5.0 to - 2.0) mmHg, p < 0.0001; - 8.1 (- 10.4 to - 5.9) mmHg, p < 0.0001l; and - 7.3 (- 9.3 to - 5.3) mmHg, p < 0.0001 in the XEN alone, XEN+PHACO, TRAB alone, and TRAB+PHACO, respectively. At month 12, an IOP ≥ 6 and ≤ 16 mm without treatment was achieved by 44 (67.7%) and 43 (76.8%), p = 0.2687 in the XEN implant and the TRAB surgery groups, respectively. The mean number of antiglaucoma medications was significantly reduced in all the study groups (p < 0.0001 each). Needling occurred in 20.0% (13/65) of eyes in the XEN implant group, while hyphema occurred in 30.4% (17/56) of eyes in the TRAB group. CONCLUSIONS XEN implant, either alone or in combination with phacoemulsification, significantly reduces both IOP and the number of antiglaucoma medications to a similar rate than trabeculectomy, but with a better safety profile.
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Affiliation(s)
- María Teresa Marcos Parra
- Ophthalmology Department, Hospital General Universitario de Alicante, Alicante, Pintor Baeza, 11, 03010, Alicante, Spain.
| | - Javier Alejandro Salinas López
- Ophthalmology Department, Hospital General Universitario de Alicante, Alicante, Pintor Baeza, 11, 03010, Alicante, Spain
| | - Noelia Soledad López Grau
- Ophthalmology Department, Hospital General Universitario de Alicante, Alicante, Pintor Baeza, 11, 03010, Alicante, Spain
| | - Ana María Ceausescu
- Ophthalmology Department, Hospital General Universitario de Alicante, Alicante, Pintor Baeza, 11, 03010, Alicante, Spain
| | - Juan José Pérez Santonja
- Ophthalmology Department, Hospital General Universitario de Alicante, Alicante, Pintor Baeza, 11, 03010, Alicante, Spain
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