Glaucoma Gel Implant Learning Curve in a Teaching Tertiary Hospital

Abstract

Purpose: The XEN gel stent is a minimally invasive surgical device aimed at creating a subconjunctival drainage of aqueous humor, thereby reducing intraocular pressure (IOP). Being a novel device, doubts remain with regard to the efficacy and safety of its implantation in the early stage of new users. This paper illustrates the XEN implantation learning curve, assessed through several surgeons of different expertise. Methods: This was a retrospective study on the first 6 XEN implants performed by each of the 10 certified ophthalmic surgeons. Simultaneous cataract surgery was allowed (phaco-XEN). Primary outcomes were as follows: surgical time; intraoperative and postoperative surgical complications. Secondary outcomes were as follows: IOP; the number of topical drugs in use; the need for needling procedures. Outcome data were collected preoperatively and at postoperative days 1, 7, 15, 30, 60, and 90. Statistical analysis was performed with STATA 14.1 and SPSS. Results: Sixty patients were included (56.7% female patients). Mean age was 73 years (45 to 89). Mean preoperative IOP was 23.8±8.95 mm Hg. From the included patients, 29 (48.3%) were submitted to simple XEN implant and 31 (51.7%) to phaco-XEN. In both groups, mean surgical time decreased by 9 minutes throughout the 6-implant learning curve. Final IOP was 15±7.27 mm Hg in the stent group (−43% than baseline), and 14.92±3.32 mm Hg in the phaco-XEN group (−16% than baseline). On average, patients decreased 2 topical IOP-lowering drugs. Needling procedures were performed in 17 patients (28.3%). Conclusions: XEN gel stent was associated with a fast learning curve, by both experienced surgeons and novice residents. By the sixth implant, both groups had considerably decreased mean surgical time and complication rates.

Cataract and glaucoma combined surgery: XEN® gel stent versus nonpenetrating deep sclerectomy, a pilot study

“…In the present study, there was indeed a clinically significant 14.82-min difference in surgery duration, which could make it possible to perform more procedures if XEN is used. This finding needs to be confirmed in a complete operating program and at least on a monthly operating volume, but XEN shows a fast learning curve by both experienced surgeons and novice residents [31], unlike the NPDS, which implies delicate dissection. However, the quality-of-life indicators remain to be determined.…”

Safety and efficacy outcomes of the Xen45 Gel Stent use for refractory glaucoma: a surgery series from surgeon trainees at a tertiary teaching hospital

“…There is a paucity of data on success rates of XEN45 Gel Stent implantations performed by surgical trainees. Marques et al [18] published 1 study examining the first 6 gel stent implantations of 5 ophthalmology resident physician trainees who had performed over 250 cataract surgeries, compared to 5 experienced ophthalmic specialist surgeons with no prior XEN45 placement experience trained by Allergan (Allergan Inc., Irvine, California, USA). Both were found to have similar mean surgical times, but residents had more intraoperative and postoperative complications such as bleb hemorrhage, XEN45 placement and drainage issues, hypotony, and transitory inflammatory reactions.…”

An Update on Microinvasive Glaucoma Surgery Concurrent With Cataract Extraction

“…Multiple recent series have demonstrated the safety and efficacy of XEN gel stent placement at the time of cataract surgery in reducing IOP and IOP lowering medication [35][36][37][38][39][40][41][42]. Interestingly, Widder et al reported that pseudophakic eyes had the most favorable primary success rate compared to phakic eyes and combined surgery with phacoemulsification, and this finding influenced their clinical decision making so as to no longer offer patients combined surgery [43].…”