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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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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.
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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
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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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4
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Martínez-de-la-Casa JM, Marcos-Parra MT, Millá-Griñó E, Laborda T, Giménez-Gomez R, Larrosa JM, Urcola A, Teus MÁ, Perucho-Martínez S. Effectiveness and safety of XEN63 in patients with primary-open-angle glaucoma. Sci Rep 2024; 14:4561. [PMID: 38402310 PMCID: PMC10894194 DOI: 10.1038/s41598-024-55287-z] [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: 10/08/2023] [Accepted: 02/22/2024] [Indexed: 02/26/2024] Open
Abstract
This paper evaluates the effectiveness and safety of XEN63 stent, either standalone or in combination with phacoemulsification, in patients with primary open-angle glaucoma (POAG). Eighty eyes from 80 patients with medically uncontrolled POAG were assigned to undergo XEN63 implant. The primary outcome was the surgical success, defined as an intraocular pressure (IOP) lowering from preoperative values ≥ 20% and an IOP absolute value between 6 and 18 mmHg, with or without antiglaucoma medications. Forty-three (53.7%) eyes underwent XEN63-standalone and 37(46.2%) eyes a XEN63 + Phacoemulsification procedure. Success rate was 68.8% (55/80) eyes in the overall study sample, 69.8% (30/43) eyes in the XEN63-standalone group; and 67.6% (25/37) eyes in the XEN63 + Phaco group (p = 0.6133). Preoperative IOP was significantly lowered from 22.1 ± 4.9 mmHg and 19.8 ± 3.7 mmHg to 14.7 ± 5.3 mmHg and 13.8 ± 3.4 mmHg in the XEN63-standalone and XEN63 + Phaco groups, respectively (p < 0.0001 each, respectively); without significant differences between them at any of the time-points measured. Preoperative number of ocular-hypotensive drugs was significantly reduced from 2.3 ± 0.8 to 0.3 ± 0.7 drugs, from 2.5 ± 0.7 to 0.3 ± 0.7 drugs; and from 2.0 ± 0.8 to 0.3 ± 0.7 drugs, in the overall, XEN63-standalone, and XEN63 + Phaco groups, respectively. Regarding safety, 3(42.5%) eyes had transient hypotony at some point during the study, although only in one (1.2%) eye was clinically significant. Four (5.0%) eyes underwent a needling, 4 (5.0%) eyes underwent surgical-bleb-revision, 1 (1.2%) eye required a device replacement and 1 (1.2%) eye a device removal due to maculopathy. XEN63, either alone or in combination with phacoemulsification, significantly lowered IOP and reduced the number of ocular hypotensive medications. The rate of ocular hypotony was relatively high, although it was clinically relevant only in one eye.
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Affiliation(s)
- José María Martínez-de-la-Casa
- Ophthalmology Unit, Department of Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Universidad Complutense de Madrid, Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain.
| | | | | | - Teresa Laborda
- Glaucoma Department. Hospital La Arruzafa, Córdoba, Spain
| | | | | | - Aritz Urcola
- Ophthalmology Department, Araba University Hospital, Álava, Spain
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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.
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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;
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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.
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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
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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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Koerber N, Ondrejka S. Clinical outcomes of canaloplasty via an ab-interno surgical technique using the iTrack device: a narrative review. Int Ophthalmol 2022; 43:2017-2027. [DOI: 10.1007/s10792-022-02601-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022]
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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.
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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
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10
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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.
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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.
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11
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Vera V, Sheybani A, Wustenberg W, Romoda L, Camejo L, Liu X, Lewis R. Compatibility and Durability of the Gel Stent Material. Expert Rev Med Devices 2022; 19:385-391. [PMID: 35615918 DOI: 10.1080/17434440.2022.2081073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The XEN Gel Stent (AbbVie Pharmaceuticals) is a device made from Gelatin; a well-known material in the medical field that is firm enough to hold its shape and soft enough to conform to tissues and reduce the risk of erosion. The Gel Stent creates a permanent outflow connection between the anterior chamber and subconjunctival space. AREAS COVERED Validation testing done on the Gel Stent to evaluate biocompatibility and durability of the material as well as real-world experience are included and discussed in this paper. EXPERT OPINION Correlating the results of the preclinical testing, study outcomes available in the published literature, and the surgeons' experiences, the device and materials have shown to have an acceptable biocompatibility and durability profile, with a stable, nondegradable, and permanent implant.
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Affiliation(s)
| | | | | | | | - Larissa Camejo
- Center for Medical and Surgical Eye Care of Jupiter, Florida, USA
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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.
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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
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