Effective treatment of a normal-tension glaucoma patient with bilateral ab externo XEN Gel Stent implantation

Harris, James M.; Valle, David Solá-Del

doi:10.1016/j.ajoc.2020.100947

Cited by 5 publications

(9 citation statements)

References 42 publications

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“…Such reports on the IOP reducing efficacy rates for adverse effects and visual recovery have been published for XEN45 9 , 10 , 11 and also for the PreserFlo Microshunt 12 . According to the literature, XEN45 was successfully applied to various forms of glaucoma, resulting in IOP readings comparable to ours 13 , 14 , 15 , 16 . However, there are fewer published studies on the PreserFlo Microshunt (industry-initiated trials), as this product has only been on the market under the current name since 2016 compared to XEN45 (since 2014).…”

Section: Discussionsupporting

confidence: 60%

Retrospective Analysis of 12 Months Glaucoma Implant Efficacy: XEN45 and PreserFlo Microshunt

Saletta

Alexoudis

Gkatzioufas

et al. 2022

Klin Monbl Augenheilkd

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Purpose Several new implant devices have recently been introduced to glaucoma surgery using various techniques for reducing intraocular pressure (IOP). Two implants introduced during the past couple of years, XEN45 and PreserFlo Microshunt, are both designed to control subconjunctival filtration. There are two Swiss multicenter studies that collected the data retrospectively to analyze the efficacy and safety of these two devices separately. In this study, we report the analysis of the combined data subset from the University Hospital of Basel. Subjects and Methods The XEN45 implantation technique was introduced to Basel University Hospital in 2016 and PreserFlo Microshunt in 2018. Sixty operated patients, thirty in each group, were operated on by one surgeon, clinically followed up, and their data retrospectively analyzed from medical records. Only standalone procedures, without combined phacoemulsification, were considered in this analysis; the lens status, however, was neither an inclusion nor an exclusion criterion. Further inclusion criteria were the diagnosis of open-angle glaucoma, no previous glaucoma surgery, other than laser trabeculoplasty, and complete medical records during the 12 months of follow-up. IOP reduction during a 12-month postoperative period was the primary outcome measure as well as the number of IOP reducing drugs. The number of subsequent surgical interventions and complications/adverse events are descriptively reported. Results Patient age, gender, ophthalmological diagnosis, and initial preoperative IOP were well balanced between the two groups. Postoperative IOP course was comparable between the two methods for the first 12 months. IOP measurements were taken preoperatively and then on the first postop day, week 1, month 1, and months 3, 6, and 12 for the PreserFlo Microshunt vs. XEN45 (mmHg): 23.6 vs. 24.9, 9.0 vs. 8.9, 11.4 vs. 10.6, 13.0 vs.18.3, 16.8 vs.15.1, 15.9 vs.15.0, and 15.4 vs.14.5, respectively. IOP reducing medications were also comparable between the two groups. The study showed that subsequent interventions were more frequent in the XEN45 (13) than in the PreserFlo Microshunt group (7). Conclusion Both methods demonstrate satisfactory IOP control within a 12-month postoperative period with practically no serious adverse events/complications, but with relatively high numbers of subsequent interventions (needlings), particularly in the XEN45 group.

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Section: Discussionsupporting

confidence: 60%

Retrospective Analysis of 12 Months Glaucoma Implant Efficacy: XEN45 and PreserFlo Microshunt

Saletta

Alexoudis

Gkatzioufas

et al. 2022

Klin Monbl Augenheilkd

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“…Although dissection of the conjunctiva requires additional operating time, the extra time in the OR may correlate with a more successful result long term. A case report by Harris and Solá-Del Valle indicates that AEO placement of XGS can be particularly useful for treating patients who require low target IOP to slow glaucoma progression 6,16 . The report follows a 54-year-old Japanese woman with uncontrolled NTG and XGS placed AEO in both eyes, resulting in sustained IOP reduction—with mean IOP equal to 10 mmHg OD and 8 mmHg OS—without any IOP-lowering medications for ~3 years after the first operation 6 .…”

Section: Discussionmentioning

confidence: 99%

“…4,5 In addition, the potential IOP-lowering benefits could make AEO a more effective approach long term. 3,6 Few studies directly compare the efficacies of ab interno versus ab externo XGS in terms of IOP-lowering and medication reduction. [7][8][9] Only one other study specifically compares AEO versus AIC approaches.…”

mentioning

confidence: 99%

“…Opening the conjunctiva requires additional surgical time and increases the risks of wound leaks, but it also provides surgeons with a better view for insertion of the XGS and more freedom to avoid existing scar tissue in the eyes of refractory glaucoma patients 4,5 . In addition, the potential IOP-lowering benefits could make AEO a more effective approach long term 3,6 …”

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confidence: 99%

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Comparing Outcomes of 45 Xen Implantation Ab Interno With Closed Conjunctiva to Ab Externo With Open Conjunctiva Approaches

El Helwe,

Ingram,

Neeson

et al. 2023

Journal of Glaucoma

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Précis: Ab externo with open conjunctiva placement may lead to improved gelatin stent (XEN® Gel Stent; Allergan™) success rate compared to ab interno with closed conjunctiva because it conferred more favorable results for intraocular pressure and medication burden reduction based on our complete and qualified success criteria. Purpose: To compare outcomes of a gelatin stent (XEN® 45 Gel Stent; XGS; Allergan™) placed either ab interno with closed conjunctiva (AIC) or ab externo with open conjunctiva (AEO) with or without cataract surgery in patients with glaucoma. Design: Retrospective, nonrandomized comparative study of 85 eyes from 85 glaucoma patients who received XGS placed either AIC (N=32) or AEO (N=53) with or without cataract surgery between July 2018 and January 2022 at Massachusetts Eye and Ear. Patients were included if they were≥18 years of age and had at least 30 days of follow-up without any disqualifying event. Results: Baseline demographics were similar between both groups, except for the glaucoma type. Both AIC and AEO procedures resulted in significant patterns of IOP and medication reduction from baseline up to 1 year. At POY1, mean IOP was reduced to 11.34±4 mmHg on 1.29±1.34 medications after AEO, and 13.70±3.32 mmHg on 2±1.81 medications after AIC. The average IOP reduction was significantly greater in the AEO group at all postoperative timepoints beyond POW2. There were significant differences in the survival curves of AEO and AIC groups under both the complete success criteria and the qualified success criteria. Under the complete success criteria, the cumulative probability of survival at POY1 was 28.5% in the AEO group and 3.8% in the AIC group. Under the qualified success criteria, the cumulative probability of survival at POY1 was 60.3% in the AEO group and 21.9% in the AIC group. Conclusion: In our study, we demonstrate that both placements reduce IOP and medication from baseline, with AEO placement having more favorable IOP and medication results, in addition to improved success rates compared to AIC placement.

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“…Although no clinical study has officially compared the effectiveness of the two methods, the ab externo method is believed to result in better bleb morphologies which consequently yield lower IOPs. 5 …”

Section: Discussionmentioning

confidence: 99%

A Case of Refractory Open-angle Glaucoma with Failed Baerveldt Glaucoma Implant and Trabeculectomy Treated with Ab Externo XEN Gel Stent Placement

Yang¹,

Amoozadeh²,

Lin³

2023

Journal of Current Glaucoma Practice

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A bstract Aim We report a case of successful intraocular pressure (IOP) management in a patient with refractory primary open-angle glaucoma (POAG) following implantation of XEN gel implant in the same hemisphere as prior failed filtering surgeries [i.e., Baerveldt glaucoma implant (BGI) and trabeculectomy bleb)]. Background Glaucoma is a major cause of blindness worldwide and is typically associated with elevated IOP and retinal ganglion cell loss. Treatment centers around decreasing IOP with eye drops and surgical interventions. The advent of minimally invasive glaucoma surgeries (MIGS) has expanded therapeutic options for patients who have failed traditional treatments. The XEN gel implant creates a shunt between the anterior chamber and the subconjunctival or sub-tenon's space, allowing for drainage of aqueous humor without significant tissue disruption. Given that the XEN gel implant also results in bleb formation, it is generally recommended to avoid placement in the same quadrant of prior filtering surgeries. Case description A 77-year-old man with a 15-year history of severe POAG of OU presents with persistently elevated IOP despite multiple filtering surgeries and maximal eye drop regimen. The patient had a superotemporal BGI in OU and a scarred trabeculectomy bleb superiorly in the right eye (OD). He underwent an open conjunctiva ab externo XEN gel implant placement in the OD in the same hemisphere as previous filtering surgeries. At 12 months postoperatively, the IOP range continues to be maintained within goal without complications. Conclusion The XEN gel implant can be successfully placed in the same hemisphere as prior filtering surgeries and can achieve goal IOP without any surgical complications at 12 months postoperatively. Clinical significance A XEN gel implant can effectively lower patients’ IOP and can be a unique surgical option in refractory cases of POAG with multiple failed filtering surgeries, even when inserted in close proximity to prior filtering surgeries. How to cite this article Amoozadeh SA, Yang MC, Lin KY. A Case of Refractory Open-angle Glaucoma with Failed Baerveldt Glaucoma Implant and Trabeculectomy Treated with Ab Externo XEN Gel Stent Placement. J Curr Glaucoma Pract 2022;16(3):192-194.

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Effective treatment of a normal-tension glaucoma patient with bilateral ab externo XEN Gel Stent implantation

Cited by 5 publications

References 42 publications

Retrospective Analysis of 12 Months Glaucoma Implant Efficacy: XEN45 and PreserFlo Microshunt

Retrospective Analysis of 12 Months Glaucoma Implant Efficacy: XEN45 and PreserFlo Microshunt

Comparing Outcomes of 45 Xen Implantation Ab Interno With Closed Conjunctiva to Ab Externo With Open Conjunctiva Approaches

A Case of Refractory Open-angle Glaucoma with Failed Baerveldt Glaucoma Implant and Trabeculectomy Treated with Ab Externo XEN Gel Stent Placement

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