Longitudinal bleb morphology in anterior segment <scp>OCT</scp> after minimally invasive transscleral ab interno Glaucoma Gel Microstent implantation

Lenzhofer, Markus; Strohmaier, Clemens; Hohensinn, Melchior; Hitzl, Wolfgang; Sperl, Philipp; Gerner, Matthias; Steiner, Veit; Moussa, Sarah; Krall, Eva Maria; Reitsamer, Herbert A.

doi:10.1111/aos.13902

Cited by 46 publications

(64 citation statements)

References 23 publications

(79 reference statements)

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“…; Lenzhofer et al. , ). During the procedure, a defined shunt between the anterior chamber and the subconjunctival space is created with a needle‐based injector ab interno, as it is created during the trabeculectomy manually ab externo.…”

Section: Discussionmentioning

confidence: 98%

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Effect of the outer stent position on efficacy after minimally invasive transscleral glaucoma gel stent implantation

Lenzhofer

Strohmaier

Sperl

et al. 2019

Acta Ophthalmologica

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Purpose: The outer stent lumen can be located either deeper (in or under Tenon's layer) or more superficially in the conjunctival stroma after the transscleral XEN Glaucoma Gel Microstent (XEN-GGM; Allergan Plc., USA) implantation. The present study aimed to investigate the effect of the postoperative conjunctival implant position on surgical success and intraocular pressure (IOP) after XEN-GGM. Methods: Prospective data from 66 consecutive open-angle glaucoma eyes of 54 patients were collected preoperatively and 1 and 2 weeks, and 1, 6 and 12 months postoperatively. The layer of implantation was determined in the first month postoperatively as intra-and subtenon or intraconjunctival depending on the location of the outer lumen of the stent in OCT (Visante OCT; Zeiss, Germany). Primary outcome measures were differences in relative IOP reduction at 12 months between the two groups. Further, complete and qualified surgical success, number of secondary needlings and number of IOP-lowering medications and absolute IOP were assessed. Results: Relative IOP reduction was higher in intra-and subtenon group (n = 37/ 66, 56%) at week 1 (À54% versus À19%, p < 0.001), week 2 (À39% versus À21%, p = 0.02), month 1 (À42% versus À28%, p = 0.035) and month 12 (À39% versus À24%, p = 0.024). The mean absolute IOP was lower in intra-and subtenon group at week 1 (10.8 [95%CI,.0] mmHg, p < 0.001) and months 12 (13.9 [95%CI,] mmHg, p = 0.041). At month 6, a lower burden for IOP-lowering medication was shown for the intra-and subtenon group (0.2 AE 0.5 versus 1.0 AE 1.1, p = 0.034). The mean number of secondary needlings, which were done in 47/66 (71%) of the eyes, was lower in the intra-and subtenon group in the first year (1.9 AE 1.7 versus 1.2 AE 1.2, p = 0.03). Qualified surgical success was higher in the intra-and subtenon group (90% versus 61%, p = 0.01) after 1 year. Conclusion: The present study demonstrates a higher efficacy achieved with lower secondary needling rates in deeper implant positions in conjunctiva after XEN-GGM.

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Section: Discussionmentioning

confidence: 98%

“…; Lenzhofer et al. , ). Overall success rates and efficacy (IOP and number of medications) results are comparable to the recently published APEX study (Reitsamer et al.…”

Section: Discussionmentioning

confidence: 98%

Effect of the outer stent position on efficacy after minimally invasive transscleral glaucoma gel stent implantation

Lenzhofer

Strohmaier

Sperl

et al. 2019

Acta Ophthalmologica

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“…[5] Studies utilizing the anterior segment optical coherence tomography (AS-OCT) have provided useful insights into the morphology of post-XEN gel stent blebs and have been helpful in the assessment of predictors for functionality. [17,32,33] De Gregorio et al noted the presence of subconjunctival microcysts near the implant at 12 months post-operative. [13] Olate-Pérez et al, in a study on 30 eyes with phaco-XEN, noted that blebs with cystic pattern and low reflectivity have better postoperative outcomes in terms of IOP at 12 months.…”

Section: Evaluation Of the Xen Blebsmentioning

confidence: 99%

“…In a long-term study on blebs post-XEN63 stent, Lenzhofer et al classified the blebs into four categories, according to the internal bleb characteristics. [33] They noted that microcystic multiform morphology (multiple cystic hyporeflective areas in deep layer separated by thin septae and having thicker bleb wall which makes the bleb appears encapsulated) at month 3 and uniform bleb morphology (no fluid-filled hyporeflective spaces in Mansouri et al [12] Several cases (% N/A) Heidinger et al [26] Implant malpositioning/ malfunction -8% Hengerer et al [25] Subconjunctival bleeding -5% Widder et al* [19] Intraoperative bleeding -9% subconjunctival space) at month 9 were associated with greater risk of failure at the 1 year follow-up. The authors also note that the subconjunctival separation morphology (multiple small spaces in more superficial layers) was associated with a lower IOP [ Figure 3].…”

Section: Evaluation Of the Xen Blebsmentioning

confidence: 99%

XEN Gel stent: A Review

Dangda¹,

Castanos²,

Do³

et al. 2019

cleverjournal

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Over the last decade, several new surgical devices and treatment options have been developed for the management of glaucoma. Together, known as micro-invasive glaucoma surgery, they aim to provide a safer approach to glaucoma surgery. Although the early devices were used to either stent or ablate a segment of the trabecular meshwork, newer devices such as the XEN gel stent (Allergan Inc., Dublin, Ireland), offer the possibility of creating a safer, more predictable filtering bleb. Since its FDA approval in 2016, several retrospective case series and prospective studies have highlighted the efficacy of the XEN gel stent with regards IOP lowering and reduction in the need for glaucoma medications. The XEN gel stent has also been shown to have a favorable safety profile in terms of intraoperative and post-operative complications. The major concern is the need for bleb intervention in the form of needling and injection of anti-fibrotic agents. This review focuses to summarize the current knowledge on the XEN gel stent for treatment of various subtypes of glaucoma.

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“…Inną możliwością jest też zwiększenie filtracji podspojówkowej, ale bez jednoczesnego nacinania i odpreparowywania spojówki, co zmniejsza ryzyko pooperacyjnego bliznowacenia i niewydolności przetoki. Jednym z takich zabiegów jest procedura wszczepienia implantu XEN®, który umożliwia drenaż cieczy wodnistej z oka do przestrzeni podspojówkowej, co oddaje zasadę działania trabekulektomii, ale zwiększa kontrolę filtracji, a zarazem nie traumatyzuje spojówki [5,12,13].…”

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