Glaucoma is a blinding optic neuropathy, the main risk factor for which is increased intraocular pressure (IOP). The trabecular meshwork, located within the iridocorneal angle, is the main pathway for drainage of aqueous humor (AH) out of the eye, and its dysfunction is responsible for the IOP elevation. The trabecular meshwork is a complex, fenestrated, threedimensional structure composed of trabecular meshwork cells (TMC) interdigitated into a multilayered organization within the extracellular matrix (ECM). The purpose of this literature review is to provide an overview of current understanding of the trabecular meshwork and its pathophysiology in glaucoma. Thus, we will present the main anatomical and cellular bases for the regulation of aqueous humor outflow resistance, the pathophysiological mechanisms involved in trabecular dysfunction in the various types of glaucoma, as well as current and future therapeutic strategies targeting the trabecular meshwork.

Purpose: The purpose of this study was to analyze the change in intraocular pressure (IOP) and glaucoma medications using the XEN® Gel Stent as a solo procedure or in association with phacoemulsification in patients with chronic open angle glaucoma (OAG). Methods:We included cohort studies with at least one year of follow-up in patients with primary open angle glaucoma (POAG), pseudo-exfoliative glaucoma (PXG) or pigmentary glaucoma (PG) who received a XEN® gel stent. The main outcome measure was IOP reduction at 12 months follow-up. Secondary outcomes were the decrease in glaucoma medications 12 months after surgery, frequency and type of postoperative interventions and complication rate. Results:A total of 8 case series published between 2016 and 2018 were included; six were prospective studies, and two were retrospective. There was no randomized controlled trial. The data concerned a total of 958 eyes of 777 patients. The various studies showed a mean IOP at 12 months between 13 and 16 mmHg, which represented an IOP reduction between 25 and 56% (mean: 42%). This decrease was associated with a reduction in glaucoma medications in all studies. The decrease in IOP was significantly greater in XEN® implantation as a stand-alone procedure (44%) than in combined surgery (32%) (p<0.05). Transient hypotony (< 1 month) (3%), choroidal detachment or choroidal folds (1.5%), hyphema (1.9%), bleb leak (1.1%) and shallow anterior chamber (1.1%) were the most frequent complications. As for severe complications, four cases of malignant glaucoma (0.4%) and one case of retinal detachment have been reported. In the follow-up period, needling has been required in 32% of cases, and a total of 55 eyes (5.7%) required repeat filtering surgery or cyclodestructive procedure. Conclusion: XEN Gel Stent appears effective for reducing IOP and the number of medications in OAG patients within 1 year postoperatively with an acceptable safety profile. However, vigilant postoperative follow-up and frequent postoperative maneuvers are required. Abstract : Purpose: The purpose of this study was to analyze the change in intraocular pressure (IOP) and glaucoma medications using XEN® implant as a solo procedure or in association with phacoemulsification in patients with chronic open angle glaucoma (OAG). Methods: We included cohort studies with at least one year of follow-up in patients affected by primary open angle glaucoma (POAG), pseudo-exfoliative glaucoma (GPEX) or pigmentary glaucoma (GPIG) who received a XEN® implant. The main outcome was IOP reduction at 12 months follow-up. Secondary outcomes were the use of glaucoma medications 12 months after surgery, postoperative intervention and complications.Results: A total of 8 case series published between 2016 and 2018 were included, six were prospective studies and two were retrospective. There was no randomized controlled trial. The data concerned a total of 958 eyes of 777 patients. Studies showed a mean IOP at 12 months between 13 and 16 mmHg, which represented an IOP reduction between 25 a...

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...

Purpose To investigate the corneal epithelial thickness topography with optical coherence tomography (OCT) and its relationship with vision quality in epithelial basement membrane dystrophy (EBMD). Methods 45 eyes of EBMD patients, 26 eyes of dry eye (DED) patients and 22 eyes of normal subjects were enrolled. All participants were subjected to 9-mm corneal epithelial mapping with OCT and vision quality was assessed with the optical quality analysis system using the objective scatter index (OSI). Central, superior, inferior, minimum, maximum, and standard deviation of epithelium thickness (Irregularity), were analysed and correlations with the OSI were calculated. Results The mean (±SD) central, inferior and maximum epithelial thicknesses of the EBMD patients (respectively, 56.4 (±8.1) μm, 58.9 (±6.4) μm, and 67.1 (±8.3) μm) were thicker compared to DED patients (P<0.05) and normal subjects (P<0.05). We found greater irregularity of epithelial thickness in EBMD (5.1±2.5 μm) compared to DED patients (2.6±1.0 μm) (P = 4.4.10−6) and normal subjects (2.1±0.7 μm) (P = 7.6.10−7). The mean OSI was worse in EBMD patients than in DED patients (P = 0.01) and compared to normal subjects (P = 0.02). The OSI correlated with the epithelial thickness irregularity (Spearman coefficient = 0.54; P = 2.65.10−5). Conclusions The OCT pachymetry map demonstrated that EBMD patients had thicker corneal epithelium in the central and inferior region. These changes were correlated with objective measurements of vision quality. This OCT characterisation of the EMBD provides a better understanding of the epithelial behaviour in this dystrophy and its role in vision quality.