Impact of failed ab-interno trabeculectomy (trabectome) on subsequent XEN45 gel stent implantation in pseudophakic eyes

Abstract

Purpose To determine the impact of failed ab-interno trabeculectomy on the postoperative outcome of subsequent XEN45 gel stent (Allergan, CA, USA) implantation in pseudophakic eyes. Methods In this retrospective single-center study, we included 60 pseudophakic eyes from 60 participants who underwent XEN45 gel stent implantation. Thirty eyes each underwent primary stent implantation (control group) or had previously undergone a failed ab-interno trabeculectomy (trabectome group). The groups were matched at a 1:1 ratio based on the following criteria: preoperative and maximum Intraocular pressure (IOP), preoperative medication score, cup/disk-ratio, follow-up time, best-corrected visual acuity at baseline, age, and the proportion of patients classified as primary open angle glaucoma or exfoliation glaucoma. We defined a successful surgery by the following three scores: an IOP reduction > 20% and IOP at the longest follow-up < 21 mmHg (Score A) or < 18 mmHg (Score B) or IOP ≤ 15 mmHg and an IOP reduction ≥ 40% (Score C). One open conjunctival revision was allowed in all scores, and a repeat surgery was considered a failure. Results Following an average follow-up period of 22 ± 12 months, we observed a mean IOP reduction of 38%, from 23.5 ± 5.2–14.5 ± 5.0 mmHg. Comparative analyses between the groups did not reveal a significant difference in the postoperative IOP, postoperative medication score, side effects, revision rate, repeat surgery rate, or success rate. Conclusions Trabectome is a viable first-line procedure for medically uncontrolled glaucoma before filtering ab-interno microstent surgery is considered.

XEN® implantation: an effective strategy to stop glaucoma progression despite prior minimally invasive glaucoma surgery

“…With regard to previous MIGS, a publication about the impact of prior Trabectome® surgery on the outcome of XEN® by Kiessling et al provides a first more differentiated analysis [54]. Even though they included eyes with exfoliative glaucoma in addition to POAG, this study is more comparable to ours.…”

“…In total, 42% of their patients underwent an open conjunctival revision surgery and 12% needed a repeated surgery. As conclusion, Kiessling et al stated that a failed Trabectome® surgery does not affect the postoperative IOP, medication score, revision rate, repeated surgery rate, and success rate of a subsequent XEN® gel implantation [54].…”

XEN®-45 implantation for refractory uveitic glaucoma

“…In this case series of XEN ® -45 implantation, a majority of 72% (18/25) previously underwent Trabectome ® surgery. Kiessling et al have shown that trabeculectomy ab interno with the Trabectome ® does not interfere with following XEN ® -45 implantation in non-uveitic pseudophakic eyes [ 13 ]. Our case series is too small to prove a difference between eyes with or without previous Trabectome ® surgery.…”