&lt;p&gt;Surgical Approaches for Implanting Xen Gel Stent without Conjunctival Dissection&lt;/p&gt;

Vera, Vanessa; Gagné, Sébastien; Myers, Jonathan S.; Ahmed, Iqbal Ike K.

doi:10.2147/opth.s265695

Cited by 30 publications

(47 citation statements)

References 12 publications

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“…XEN gel stent is widely implanted through ab-interno approach, however it can be successfully implanted ab-externo as well (59,62,75,82,83). Vera et al (84) have verified that both ab-interno and ab-externo approaches for XEN implantation allowed surgeons to better optimize surgery according to the patient's personal conditions, and allows customized surgery to better adapt to the surgeon's preferences. Tan et al (59), Ucar and Cetinkaya (62) and Do et al (75) reported that there were no differences in outcomes between ab-interno and abexterno approaches of the XEN implantation in terms of the IOP reduction and the success rate.…”

Section: Discussionmentioning

confidence: 99%

The Outcomes of XEN Gel Stent Implantation: A Systematic Review and Meta-Analysis

et al. 2022

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PurposeXEN gel stents are used for the treatment of open-angle glaucoma (OAG), including primary and secondary glaucoma that are uncontrolled by previous medical therapy and cases with previous failed surgery. Our aim was to systematically review of the clinical data of currently published ab-interno XEN gel stents with an emphasis on intraocular pressure (IOP), antiglaucoma medication outcomes, and safety profiles.MethodsWe analyzed all of the publications (MEDLINE, EMBASE, Cochrane Library) on the ab-interno XEN gel stent to evaluate the reduction in IOP and antiglaucoma medications following the procedure. The primary outcomes measured for the meta-analysis were reduction in IOP and anti-glaucoma medications. The secondary outcome were adverse events. For each study, we used a random effects analysis model to calculate the mean difference and 95% confidence intervals for the continuous results (reduction in IOP and antiglaucoma medications) using the inverse variance statistical method.ResultsFive hundred twenty-seven articles were checked and 56 studies were found to be relevant with a total of 4,410 eyes. There was a significant reduction in IOP as well as in the number of medications required in patients treated with ab-interno XEN implant either alone or combined with cataract surgery. This new treatment for various types of glaucoma reduced the IOP by 35% to a final average close to 15 mmHg. This reduction was accompanied by a decrease in the number of antiglaucoma medications in all the studies, approximately 2 classes of medication at the price of more needlings. The overall complete success rate was 21.0–70.8% after 2 years using strict criteria originally designed to record success rate in filtration surgery. The incidence of complications vision-threatening was low at <1%.ConclusionsXEN gel stent was effective and safe for primary and secondary OAG. Further studies should be performed to investigate the impact of ethnicity on the success and failure rate after XEN implantation.

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Section: Discussionmentioning

confidence: 99%

The Outcomes of XEN Gel Stent Implantation: A Systematic Review and Meta-Analysis

et al. 2022

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“…In addition, the findings reflect results of surgical approaches that may not represent current preoperative preparation methods, refinements in surgical techniques, and peri-and postoperative practices. The gel stent-related surgical techniques are indeed evolving rapidly, with a major emphasis on the implant's distal end being placed supra-or sub-Tenon, which can be achieved via abinterno or ab-externo approaches, with or without conjunctival dissection (Panarelli et al 2020;Vera et al 2020). Other practices, such as preoperative control of inflammation by avoiding topicals with preservatives and/or using steroids, primary needling at the time of implantation and modulation of fibrosis with a 5-fluorouracil regimen, are being incorporated into clinical practice (Lenzhofer et al 2019;Vera et al 2019;Panarelli et al 2020;Vera et al 2020;Wałek et al 2020).…”

Section: Discussionmentioning

confidence: 99%

Three‐year effectiveness and safety of the XEN gel stent as a solo procedure or in combination with phacoemulsification in open‐angle glaucoma: a multicentre study

Reitsamer

Vera²,

Ruben

et al. 2021

Acta Ophthalmologica

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Purpose: To assess the 3-year effectiveness and safety of the XEN gel stent implanted ab interno in open-angle glaucoma (OAG). Methods: This study was a multicentre, retrospective chart review of consecutive patients with OAG who underwent ab-interno gel stent placement alone or combined with phacoemulsification between 1 January 2014 and 1 October 2015. Outcome measures included mean changes in intraocular pressure (IOP) and IOP-lowering medication count from medicated baseline at 1, 2, 3 (primary outcome) and 4 years (if available) postimplantation. Intraoperative complications, adverse events of special interest (AESIs) and secondary surgical interventions (SSIs) were recorded. Results: The safety and effectiveness populations included 212 eyes (primary and secondary) and 174 eyes (primary), respectively. Mean IOP and medication decreased from 20.7 mmHg and 2.5 at baseline (n = 163 primary/first implanted eyes) to 13.9 mmHg and 1.1 medications (n = 76) at 3 years postimplantation, respectively. Mean changes from baseline in IOP (À5.6, À6.2 and À6.6 mmHg) and IOP-lowering medication count (À1.8, À1.6 and À1.4) were statistically significant at 1, 2 and 3 years postimplantation, respectively. Results appeared comparable when implantation was performed with (n = 76) or without (n = 98) phacoemulsification. In primary eyes with 4-year IOP and medication count data (n = 27), mean IOP was 14.0 mmHg on 1.3 medications at 4 years postimplantation. Fifteen (7.1%) eyes had intraoperative complications, 31 (14.6%) experienced 46 postoperative AESIs, and 26 (12.3%) required SSI. Conclusion:The gel stent effectively lowered IOP and IOP-lowering medication count over 3 years, with a predictable and acceptable safety profile, when implanted via the traditional ab-interno technique.

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“…Two papers were recently published that detail different techniques using both ab interno and ab externo approaches, with and without conjunctival dissection. 7 , 8 The authors of this paper sought to compare the outcomes of the most commonly reported closed conjunctiva, ab interno placement technique, with an open conjunctiva, ab externo approach that has been adopted by the operating surgeon (NMR). This retrospective chart review compares the outcomes using these two different techniques.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Safety and Efficacy Between Ab Interno and Ab Externo Approaches to XEN Gel Stent Placement

Tan

Tracer

Terraciano

et al. 2021

OPTH

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Purpose: To compare the safety and efficacy of two different techniques for implantation of the XEN Gel Stent, a minimally invasive surgical device for the treatment of refractory glaucoma. Methods: A retrospective chart review of eyes that received ab interno or ab externo XEN Gel Stent placement from February 2017 to October 2019 was conducted. A single surgeon (NMR) performed all operations. Eyes that received the XEN implant concomitant with a glaucoma drainage device insertion or that were lost to 6-month follow-up were excluded. Intraocular pressure (IOP) change, change in glaucoma medications, frequency of slit lamp revision procedures, and frequency of secondary glaucoma surgeries were the primary outcomes compared between groups. Results: Fifty eyes that underwent ab interno placement and 30 eyes that underwent ab externo placement were studied. The ab interno cohort demonstrated a mean IOP reduction of 8.4 ± 1.7 mmHg (28.6% decrease) by 12 months, compared to a mean reduction of 12.8 ± 3.0 mmHg (40.1% decrease) in the ab externo group (p = 0.208). Mean reduction in medication use was 1.81 ± 0.29 medications in the ab interno group and 1.86 ± 0.37 in the ab externo group (p = 0.913). By 12 months, 58% of ab interno eyes had required 5-fluorouracil injection compared to 36.7% of ab externos (p = 0.105). Bleb needling was applied to 42% and 26.7% of the eyes, respectively (p = 0.231). A second glaucoma surgery was necessary for 20% of the ab interno cohort and 10% of the ab externo cohort (p = 0.351). Conclusion: There were no differences in outcomes between ab interno and ab externo placement of the XEN Gel Stent. Both approaches are safe and effective for lowering IOP.

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<p>Surgical Approaches for Implanting Xen Gel Stent without Conjunctival Dissection</p>

Cited by 30 publications

References 12 publications

The Outcomes of XEN Gel Stent Implantation: A Systematic Review and Meta-Analysis

The Outcomes of XEN Gel Stent Implantation: A Systematic Review and Meta-Analysis

Three‐year effectiveness and safety of the XEN gel stent as a solo procedure or in combination with phacoemulsification in open‐angle glaucoma: a multicentre study

Comparison of Safety and Efficacy Between Ab Interno and Ab Externo Approaches to XEN Gel Stent Placement

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