The purpose of this study is to evaluate the efficacy and complications of the XEN implant as a solo procedure or in association with cataract surgery in patients with open angle glaucoma (OAG). All patients who received a XEN implant between June 2017 and June 2018 were included in the study. The primary and secondary outcomes were: the reduction of the intraocular pressure (IOP) at 6 months postoperatively, the decrease of the glaucoma medications 6 months after surgery, the clinical success rate (eyes (%) achieving ≥20% IOP reduction on the same or fewer medications without secondary surgical intervention), the frequency and type of postoperative interventions as well as the complication rate. We included one hundred and seven eyes from 97 patients with primary OAG (79%), or secondary OAG (21%). Seventy-seven patients (72%) received a standalone XEN implantation and 30 (28%) underwent XEN implantation combined with phacoemusification. The IOP decreased from 20.4 mm Hg ± 6.4 preoperatively to 15.4 mm Hg ± 5.3 six months after the surgery, which represented a reduction of 24.5% (P = 1.4.10 −7). It was associated with a lowering of glaucoma medications from 2.8 ± 1.0 preoperatively to 0.6 ± 1.0 six months postoperatively (P = 3.6.10 −34). The clinical success rate was 67.2% six months after the surgery. The most frequent complications were: IOP spikes >30 mmHg (16.8%), improper position or angled drain (14.0%) and transient minimal hyphema (<1 week) (11.2%). During the follow-up, the needling was required in 34.6% of cases and a total of 10 eyes (9.4%) required a new glaucoma surgery. To conclude XEN implantation appears to be an effective short-and midterm surgical technique to control IOP in OAG with a low risk of complication. However postoperative maneuvers were frequently required to maintain efficiency. Glaucoma is the first cause of irreversible blindness 1. It is a optic neuropathy that affects more than 70 million people worldwide 2. Nowadays, reducing the intraocular pressure (IOP) is the only effective therapeutic strategy to stop the progression of glaucoma 3-5 , it includes pressure-lowering eye-drops, laser treatments and surgery. In the case of open angle glaucoma (OAG), the most performed glaucoma surgeries are trabeculectomy and non-penetrating deep sclerectomy (NPDS). These two techniques are based on a derivation of the aqueous humor towards the subconjunctival space by creating a filtration bleb (FB). As effective these filtering surgeries are, they are also accompanied by a non-negligible rate of complications such as postoperative bleb leakage, hypotony, and cataract 6-8. Fibrosis of the bleb is responsible for the majority of surgical failures 7. Rarely, an infection of the filtering bleb occurs, exposing the eye to a risk of endophthalmitis 7,8. Consequently, innovative glaucoma surgery techniques and devices described as "Minimally Invasive Glaucoma Surgeries" (MIGS) have been developed. XEN is one of these new minimally invasive therapeutic option (used for the IOP reduction procedure) c...

Précis: The nonpenetrating deep sclerectomy (NPDS) procedure resulted in significantly more surgical success than the standalone XEN gel stent procedure without differences in safety profile. Purpose:The purpose of this study was to compare surgical success and safety profile of NPDS and XEN gel stent.Methods: A retrospective chart review of 328 eyes of 282 patients who were scheduled for standalone XEN gel stent surgery (n = 140) or NPDS (n = 188) at Groupe Hospitalier Paris Saint-Joseph between January 2017 and December 2018 was conducted. Primary outcome measure was the proportion of surgical success 12 months after surgery. Complete and qualified surgical successes were defined by intraocular pressure (IOP) ≤ 18 mm Hg and a reduction of IOP ≥ 20% without or with hypotensive medication, respectively.Results: In total, 82 eyes were included in the XEN group and 124 eyes in the NPDS group. In the 1-eye analysis, rates of "complete success" and "qualified success" were, respectively, at the end of follow-up, 28.57% and 20.00% in the XEN group, and 42.72% and 16.50% in the NPDS group (P = 0.17). Success probability plots based on the Kaplan-Meier estimate for overall surgical success demonstrated a median success probability time of 3.73 years for the NPDS group and 2.38 years for the XEN group (P < 0.0001). After adjustment for confounding variables using Cox regression, the NPDS procedure was significantly more associated with surgical success than the XEN gel stent implantation (P < 0.001). No difference was demonstrated in terms of reduction of antiglaucoma medications, needling procedures, or reoperations. Conclusions:The NPDS procedure may be more effective than the XEN gel stent in reducing IOP in patients with open angle glaucoma and may result in longer surgical success. However, a well-conducted prospective randomized study is required to confirm these results.

Purpose: The purpose of this study was to evaluate the efficacy and safety of subliminal cyclophotocoagulation using a 25% duty cycle diode laser (Supra 810, SubCyclo, Quantel Medical). Methods: This was a pilot study of patients who underwent a SubCyclo photocoagulation procedure with a 25% duty cycle, between April 2016 and April 2017 at the Glaucoma Institute of Saint Joseph Hospital of Paris. All patients presented with an evolving moderate to severe glaucoma that were resistant to previous surgical treatments or with a contraindication for filtration surgery. Laser settings were programmed as follows: power 2000 mW, “on” time 0.63 ms, “off” time 1.9 ms, and 25% duty cycle per 100 seconds to each eye. Results: A total of 44 eyes of 34 patients were treated with subliminal cyclophotocoagulation, with a mean follow-up time of 12 months. Surgical success was defined as IOP ranging 6 to 21 mm Hg or a 20% IOP reduction at the last 12 months follow-up visit. The mean age of patients was 63.83±16.2 years. The mean preoperative IOP was 32.8±11.8 mm Hg which then decreased postoperatively to 24.02±7.03 mm Hg after 1 day, 18.34±8.31 mm Hg after 1 week, 18.26±8.53 mm Hg after 1 month, 20.5±8.53 mm Hg after 3 months, 18.9±9.2 mm Hg after 6 months and 18.8±9.3 mm Hg after 12 months. Our preliminary study using Subcyclo transscleral cyclophotocoagulation with a 25% duty cycle showed a 37% IOP reduction from the baseline after 3 months with a single laser session and a 45% reduction at the last 12 months follow-up, after more than one laser session. The mean number of ocular antihypertensive medications used was 3.4±1.7 before treatment which decreased to 3.0±1.6 after treatment. No significant complications or anatomic modifications were found after subliminal cyclophotocoagulation. Conclusions: Subliminal cyclophotocoagulation with a 25% duty cycle is a safe and effective procedure for reducing IOP in cases of refractory glaucoma and seems to be safer than conventional transscleral cyclophotocoagulation.

Précis: Subliminal subthreshold transscleral cyclophotocoagulation (SS-TSCPC) with duty cycles 25% and 31.3% seems to be an effective approach to reduce intraocular pressure (IOP) in glaucoma that is refractory to medical management. Objective: The objective of this study was to compare the effectiveness and the tolerance of SS-TSCPC with a duty cycle of 25% versus 31.3% with Supra 810 nm Subliminal Quantel Medical laser stimulation for advanced glaucoma. Materials and Methods: This was a retrospective, single-center, comparative case series of patients treated by SS-TSCPC between January 2017 and July 2017. The diagnostic and inclusion criteria were patients with advanced and refractory glaucoma, defined as IOP >21 mm Hg on maximal tolerated medical therapy with or without previous glaucoma surgical procedures, a minimum follow-up of 12 months, and patients who refused or were poor candidates for additional filtering surgery or implantation of glaucoma drainage devices. The primary endpoint was surgical success defined as an IOP of 6 to 21 mm Hg or a reduction of IOP by 20% from baseline without an increase in glaucoma medication from baseline. The secondary endpoints were the mean IOP and best visual corrected acuity best-corrected visual acuity at 12 months after surgery, retreatment outcomes, glaucoma medications, and complications such as inflammation, uveitis, cataract, mydriasis, and phthisis. Results: Forty eyes of 32 patients were included: 20 eyes were subjected to SS-TSCPC with 31.3% duty cycle and 20 eyes with a 25% duty cycle. The surgical success of the TSCPC 12 months after the first procedure was better in the 31.3% duty cycle group (83.5%) than in the 25% duty cycle group (65%). The most common complications were inflammation (50%, 1 mo after surgery) and IOP spikes (increase in IOP of >25% from baseline within 1 mo of laser) in both groups. Inflammation was higher in the 31.3% duty cycle group. Conclusions: SS-TSCPC at 31.3% and 25% duty cycle seems to be an effective approach to reduce IOP in glaucoma that is refractory to medical management. SS-TSCPC at 31.3% duty cycle is more effective than the 25% duty cycle SS-TSCPC. However, the 31.3% duty cycle SS-TSCPC induces more inflammation than the 25% duty cycle SS-TSCPC. Each procedure should be considered on a case by case basis.

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