A retrospective review of XEN implant surgery: efficacy, safety and the effect of combined cataract surgery

Nicolaou, Symeon; Khatib, Tasneem; Lin, Zhiheng; Sheth, Twishaa; Ogbonna, Golden; Hamidovic, Lamia; Zaheer, Asad; Dimitriou, Chrysostomos

doi:10.1007/s10792-021-02069-5

Cited by 9 publications

(12 citation statements)

References 26 publications

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“…However, some studies focused on the efficacy of XEN implantation in the treatment of secondary openangle glaucoma, including pseudoexfoliative glaucoma (52,60,(67)(68)(69)(70) and glaucoma secondary to uveitis (34). Furthermore, a few studies introduced this gel stent to narrow-or closeangle glaucoma (13,15,16,(18)(19)(20)(21)50). All patients were treated and followed as routine clinical practice between May 2013 and February 2020.…”

Section: Overall Resultsmentioning

confidence: 99%

“…Eyes requiring complementary medications were defined as qualified successes. This definition was used in seven studies (13,14,16,34,50,53,55). The complete success rate was 74.0-89.2% after 1 year (based on n = 4 studies) and 21.0-70.8% after 2 years (n = 3).…”

Section: Overall Resultsmentioning

confidence: 99%

“…The most common complication was transient hypotony (9.59%). Hypotony was defined as IOP <6 mmHg regardless of outcome in most studies (16,19,27,29,33,34,36,50,51,74), and only 3 studies defined IOP as <5 mmHg (20,37,45). Most patients who experienced hypotony do not require additional surgical intervention and will be relieved within 1 month.…”

Section: Complicationsmentioning

confidence: 99%

“…Other types of glaucoma include pigmentary glaucoma, uveitic secondary glaucoma, juvenile open-angle glaucoma, and steroid-induced glaucoma, etc. Some studies enrolled patients with ocular hypertension to reduce IOP (12)(13)(14)(15)(16). Other studies introduced XEN to patients with primary angle-closure glaucoma (PACG), although it was originally a contraindication (9,13,(16)(17)(18)(19)(20)(21).…”

Section: Introductionmentioning

confidence: 99%

“…Some studies enrolled patients with ocular hypertension to reduce IOP (12)(13)(14)(15)(16). Other studies introduced XEN to patients with primary angle-closure glaucoma (PACG), although it was originally a contraindication (9,13,(16)(17)(18)(19)(20)(21). Details on the degree of narrow angles were not reported in all studies.…”

Section: Introductionmentioning

confidence: 99%

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The Outcomes of XEN Gel Stent Implantation: A Systematic Review and Meta-Analysis

et al. 2022

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PurposeXEN gel stents are used for the treatment of open-angle glaucoma (OAG), including primary and secondary glaucoma that are uncontrolled by previous medical therapy and cases with previous failed surgery. Our aim was to systematically review of the clinical data of currently published ab-interno XEN gel stents with an emphasis on intraocular pressure (IOP), antiglaucoma medication outcomes, and safety profiles.MethodsWe analyzed all of the publications (MEDLINE, EMBASE, Cochrane Library) on the ab-interno XEN gel stent to evaluate the reduction in IOP and antiglaucoma medications following the procedure. The primary outcomes measured for the meta-analysis were reduction in IOP and anti-glaucoma medications. The secondary outcome were adverse events. For each study, we used a random effects analysis model to calculate the mean difference and 95% confidence intervals for the continuous results (reduction in IOP and antiglaucoma medications) using the inverse variance statistical method.ResultsFive hundred twenty-seven articles were checked and 56 studies were found to be relevant with a total of 4,410 eyes. There was a significant reduction in IOP as well as in the number of medications required in patients treated with ab-interno XEN implant either alone or combined with cataract surgery. This new treatment for various types of glaucoma reduced the IOP by 35% to a final average close to 15 mmHg. This reduction was accompanied by a decrease in the number of antiglaucoma medications in all the studies, approximately 2 classes of medication at the price of more needlings. The overall complete success rate was 21.0–70.8% after 2 years using strict criteria originally designed to record success rate in filtration surgery. The incidence of complications vision-threatening was low at <1%.ConclusionsXEN gel stent was effective and safe for primary and secondary OAG. Further studies should be performed to investigate the impact of ethnicity on the success and failure rate after XEN implantation.

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Section: Overall Resultsmentioning

confidence: 99%

Section: Overall Resultsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Outcomes of XEN Gel Stent Implantation: A Systematic Review and Meta-Analysis

et al. 2022

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Swiss Multicenter Ab Interno XEN45 Gel Stent Study: 2-Year Real-World Data

Papazoglou,

Höhn,

Schawkat

et al. 2024

Ophthalmol Ther

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Introduction The aim of this study was to investigate the 2-year postoperative efficacy of the XEN45 Gel Stent by evaluating the reduction of intraocular pressure (IOP) and the need for eye pressure-lowering medications in a multicenter setting in Switzerland. Methods Patients with various types of glaucoma who received a XEN45 Gel Stent with or without combined phacoemulsification cataract surgery at five hospitals in Switzerland were retrospectively enrolled. Pre- and postoperative IOP, the number of antiglaucoma medications, and the need of subsequent interventions to control IOP were assessed. The success rate was defined as a ≥ 20% reduction of IOP 2 years postoperatively without the need for subsequent glaucoma surgery. Results A total of 345 eyes were included: 44.3% with primary open-angle, 42.0% pseudoexfoliation, and 13.7% with other types of glaucoma. Of these, 206 patients were followed for 2 years. Preoperatively, the mean IOP was 26.3 ± 8.9 mmHg and the mean number of antiglaucoma medications administered was 3.0 ± 1.3. Two years postoperatively, the success rate was 66.0% (95% confidence interval 59.3–72.1%), the IOP had dropped by 43.8% to 14.8 ± 5.7 mmHg, and the number of medications was reduced by a mean of 2.0 ± 1.7 per day. Postoperative complications and the need for interventions remained low. Conclusion The XEN45 Gel Stent successfully reduced IOP and the number of antiglaucoma drugs in most patients at 2 years postoperatively.

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Occlusion of Xen Gel Stent With Descemet’s Membrane Relieved by Nd:YAG Laser

Strong Caldwell,

Gill,

St. Peter

2024

Journal of Glaucoma

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The Xen gel stent is a minimally invasive glaucoma surgical implant designed to decrease intraocular pressure by creating an aqueous outflow path into the subconjunctival space. Since FDA approval, it has demonstrated good safety and efficacy data, however there are multiple reports of Xen stent occlusions with debris from the anterior chamber. Herein, we report a case of a Descemet’s membrane Xen stent occlusion in a 67-year-old woman with past medical history of primary open angle glaucoma who underwent Xen stent placement via the ab externo approach. Her Descemet’s membrane occlusion was successfully managed by Nd:YAG laser lysis. While uncommon, small Descemet’s tears or flaps can occlude the ostia of Xen stents causing elevated intraocular pressure or bleb failure. Few reports have described the use of Nd:YAG laser to successfully treat ostium occlusion of any kind with the Xen stent. We discuss the importance of early Nd:YAG laser to relieve Descemet’s membrane occlusions, lower intraocular pressure, and rescue the bleb from failure.

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A retrospective review of XEN implant surgery: efficacy, safety and the effect of combined cataract surgery

Cited by 9 publications

References 26 publications

The Outcomes of XEN Gel Stent Implantation: A Systematic Review and Meta-Analysis

The Outcomes of XEN Gel Stent Implantation: A Systematic Review and Meta-Analysis

Swiss Multicenter Ab Interno XEN45 Gel Stent Study: 2-Year Real-World Data

Occlusion of Xen Gel Stent With Descemet’s Membrane Relieved by Nd:YAG Laser

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