Comparing Medium-Term Clinical Outcomes following XEN® 45 and XEN® 63 Device Implantation

Abstract

Purpose. To evaluate medium-term clinical outcomes with XEN® 45 or XEN® 63 Gel Stent (Allergan, Dublin, Ireland) for treatment of primary open angle glaucoma (POAG). Materials and Methods. Retrospective, descriptive, and observational study involving 40 patients implanted with a XEN® 45 Gel Stent and 34 implanted with a XEN® 63 Gel Stent who had undergone POAG surgery and had been followed up and controlled between 12 and 36 months. Results. IOP dropped from 18.02 ± 5.23 mmHg preop to 13.81 ± 1.88, 14.80 ± 2.23, and 14.62 ± 1.90 at 1, 2, and 3 years after surgery (p<0.001) consecutively with XEN® 45 and from 19.00 ± 6.11 mmHg preop to 15.47 ± 2.45, 14.66 ± 2.45, and 15.46 ± 2.48 at 1, 2, and 3 years after surgery (p<0.001) with XEN® 63. The number of drugs used by patients to treat their glaucoma decreased after undergoing surgery in both groups. Within the XEN® 45 group, mean changes at 1 year, 2 years, and 3 years amounted to 70%, 74.3%, and 37.5%, respectively, whereas within the XEN® 63 group, the mean reduction was 75%, 79.8%, and 71.9%. When comparing the outcomes for two groups, the differences did not prove to be statistically significant. More than 90% of the procedures included in the study (using either gel-stent device) were completed without any noteworthy complications. Conclusion. POAG surgical procedures with either XEN® 45 or XEN® 63 Gel Stent implantation could be a safe and effective treatment approach.

Mycobacterium Avium Paratuberculosis: A Disease Burden on the Dairy Industry

“…After infection is established, MAP colonizes the macrophages and dendritic cells in the distal ileum of the bovine intestines, where it modulates the intracellular environment, cell surface molecules, and cytokine release to maintain a prolonged intracellular presence [ 25 ]. The anti-inflammatory cytokine IL-10 represses inflammatory immune responses allowing the growth of MAP within macrophages [ 28 ]. Host compounds appear to stimulate MAP invasion and colonization [ 26 ].…”

“…Once excreted, MAP can survive outside the host for 12 weeks and up to 120 weeks in soil or water [ 40 ]. Internalization within free-living amoeba promotes the survival of MAP and other pathogens ( Legionella , Listeria , Campylobacter jejuni , Helicobacter pylori ) in aquatic environments [ 41 ] and promotes chlorine resistance [ 28 ]. MAP also demonstrates resistance to high temperatures and low pH, where humidity and UV light can reduce the environmental survival time of the pathogen [ 40 ].…”

“…MAP has a long incubation period prior to the manifestation of Johne’s disease, making early detection difficult, as seen with many endemic diseases [ 47 ]. In the clinical stage of disease, an animal may transmit to adjacent animals, depending on factors such as close contact and animal husbandry [ 28 ]. Diagnostic tools available for detection differ in their sensitivity and specificity, confounding data on herd prevalence.…”

“…JD results in reduced milk production, fertility issues, and eventual animal culling [ 48 ]. At herd level, economic costs relate to disease prevention, diagnosis, monitoring, animal replacement costs, reduced feed conversion ratio, susceptibility to comorbidities, and slaughter costs [ 28 ]. Importantly, increased incidence of clinical mastitis and/or subclinical mastitis may be associated with MAP infection in dairy cows [ 51 ], increasing disease treatment costs at cow and herd level.…”

“…The economic impact of paratuberculosis at herd level is dependent on the herd size, infection rate, bacterial shedding, display of clinical symptoms, and cases of clinical disease [ 52 ]. Reduced milk yield is evident in subclinically infected cows and is more pronounced in clinically infected animals, with a reduction of 15 and 19.5%, respectively [ 28 ]. Farmers often cull animals with a low or decreased milk yield and replace the animal with a more efficient milk-producing cow, increasing replacement costs.…”