Outcome of a single XEN microstent implant for glaucoma patients with different types of glaucoma

Schargus, Marc; Teilig, Therese; Rehák, Matúš; Busch, Catharina; Bormann, Caroline; Unterlauft, Jan Darius

doi:10.21203/rs.3.rs-38738/v4

Cited by 4 publications

(7 citation statements)

References 19 publications

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“…Since the type of glaucoma is discussed regarding its influence on the outcome of glaucoma surgery [17,18], its effect was included in our statistical approach. Thus, we evaluated our entire data taking both the diagnosis as well as surgery into account.…”

Section: Discussionmentioning

confidence: 99%

Two-Year Outcome of Surgery in Glaucoma Patients

Hüppi

Wagels

Todorova

2022

Klin Monbl Augenheilkd

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Purpose To evaluate the 2-year surgical treatment outcome in glaucoma patients. Methods A retrospective, single-center, interventional study was performed on 160 eyes of 125 patients suffering glaucoma, including POAG (82 eyes), pseudoexfoliation (PEX) (59 eyes), pigment dispersion (8 eyes), and secondary glaucoma (2 eyes). Eyes with uncontrolled intraocular pressure (IOP) or signs of glaucoma progression despite medical treatment were included to undergo either trabeculectomy (TE), XEN implantation, combined TE with phacoemulsification (TE + IOL), or XEN implantation with phacoemulsification surgery (XEN + IOL). Primary efficacy outcome was the mean IOP reduction. Secondary outcome was the mean reduction in the number of medications. The data were compared at baseline vs.1 day, 1 week, and 1, 3, 6, 12, and 24 months following surgery. For statistical evaluation, ANOVA-based linear mixed-effects models were performed with SPSS. Results The mean IOP reduction in a 2-year follow-up was 30.31% (22.17 vs. 15.45 mmHg, p < 0.001). The mean number of antiglaucoma medications was reduced from 2.87 to 0.58 (p = 0.001), where TE alone or combined surgeries seemed to be more effective than isolated XEN surgery. Transient IOP hypotony on the first postoperative day occurred in PEX patients following TE surgery (p = 0.024). At 6 months, PEX patients with isolated XEN surgery showed a transient IOP increase, whereas those after combined TE + IOL surgery showed the lowest IOP within the PEX group compared to other glaucoma patients (p < 0.026). Conclusions After 2 years, all performed glaucoma surgeries achieved a significant reduction in IOP and the number of antiglaucoma medications.

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Section: Discussionmentioning

confidence: 99%

Two-Year Outcome of Surgery in Glaucoma Patients

Hüppi

Wagels

Todorova

2022

Klin Monbl Augenheilkd

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“…Data on the rate of postoperative needling following a primary TE or a primary XEN implantation in the literature vary. A number of studies observed needling rates of 33-45 % during the first 12 months after a primary XEN implantation [10,11,26], and 32.5-53 % after a secondary XEN implantation [23,24]. In the APEX study, a needling rate of 41.1 % (n = 83/202) was observed after 24 months; there was no statistically significant difference for this parameter between the two study populations analyzed (XEN implantation only or XEN implantation in combination with a cataract operation) [10].…”

Section: Discussionmentioning

confidence: 99%

“…Es handelt sich um ein 6 mm langes Gelatineröhrchen mit einem äußeren Durchmesser von 150 µm und einem Lumen von 45 µm, welches das Kammerwasser unter Umgehung der physiologischen Abflusswege aus der Vorderkammer unter die Bindehaut leitet, wo es über eine sich im Verlauf bildende Filtrationszone im Sinne eines Sickerkissens resorbiert wird. Somit kann eine Reduzierung des IOD sowie der nötigen applizierten Medikamente bei gutem Sicherheitsprofil erreicht werden [10,11].…”

Section: Methodsunclassified

“…This device is a 6 mm-long gelatin tube with an external diameter of 150 µm and a lumen of 45 µm which drains aqueous fluid out of the anterior chamber and into the subconjunctival space, bypassing the physiological drainage system; from there the fluid is reabsorbed through a filtration zone, similar to a bleb, which forms during the course of the process. This enables to reduce the IOP as well as to reduce the need to apply medication, whilst maintaining a good safety profile [10,11].…”

Section: Introductionmentioning

confidence: 99%

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Implantation of XEN After Failed Trabeculectomy: an Efficient Therapy?

Bormann

Schmidt

Busch

et al. 2021

Klin Monbl Augenheilkd

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Background Trabeculectomy (TE) has been the standard procedure in glaucoma surgery for a long time. This study examined the efficacy and safety profile of XEN45 Gel Stent (XEN) after failed and/or scarred trabeculectomy. Material and Methods We analysed all files of patients, who received a XEN after insufficient TE and examined changes in intraocular pressure (IOP), IOP-lowering medication, best corrected visual acuity, visual field tests as well as the intra- and postoperative complications recorded within a 12-month follow-up period. Results 31 eyes of 28 patients were analysed in our study (mean age: 66,2 ± 13,4 years; 39% female; 48% right eye; mean follow-up after TE: 70,3 ± 64,9 months). The mean IOP decreased from 23,5 ± 6,5 to 18,0 ± 5,3 mmHg (− 23,5% compared to baseline-IOP; p = 0,01) while the mean IOP-lowering medication could be reduced from 2,8 ± 1,1 to 1,1 ± 1,5 (p < 0,01) 12 months after XEN-implantation. The mean visual acuity did not change significantly (pre-op: 0,5 ± 0,6 logMAR; 12 months post-op: 0,5 ± 0,6 logMAR). The most common complications postoperatively were choroideal detachment due to postoperative hypotony in 4 eyes (13%), a needling procedure in 9 eyes (29%), a Re-XEN-Implantation in 4 eyes (13%), an open revision of the conjunctiva in 3 eyes (10%), and a Re-TE in 1 eye (3%) as well as an Ahmed-Valve implantation in 2 eyes (6%). Overall, neither needling procedure nor further glaucoma surgery was necessary in 19 eyes (61%). In 10 of 22 evaluable eyes (45%) an IOP reduction of > 20% was achieved 12 months after XEN implantation. Conclusion XEN could be an effective method to reduce IOP after failed TE. The rate of complications seems to be low and the rate of needling procedures and/or revisions is acceptable.

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“…123 In another study, XEN gel stent appeared to be as effective or more effective in IOP reduction as it is a bleb raising procedure (but less hypotony than trabeculectomy): the IOP for NTG group reduced from 16.6 ± 3.4 to 11.6 ± 2.2 mmHg. 124 Dataset with longer duration of follow-ups will be needed to see long term efficacy and safety of these MIGS devices.…”

Section: Updates In Treatment: Surgical Interventions Lasers and Newe...mentioning

confidence: 99%

Normal‐tension glaucoma: Current concepts and approaches‐A review

Leung

Tham

2022

Clinical Exper Ophthalmology

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Normal tension glaucoma (NTG) has remained a challenging disease. We review, from an epidemiological perspective, why we should redefine normality, act earlier at lower pre-treatment intraocular pressure (IOP) level, and the role of ocular perfusion pressures, noting that perfusion is affected by defective vascular bed autoregulation and endothelial dysfunction. The correlation of silent cerebral infarcts (SCI) and NTG may indicate that NTG belongs to a wider spectrum of small vessel diseases (SVD), with its main pathology being also on vascular endothelium. Epidemiological studies also suggested that vascular geometry, such as fractal dimension, may affect perfusion efficiency, occurrence of SCI, SVD and glaucoma. Artificial intelligence with deep learning, may help predicting NTG progression from vascular geometry. Finally, we review latest evidence on the role of minimally-invasive glaucoma surgery, lasers, and newer drugs. We conclude that IOP is not the only modifiable risk factors as, many vascular risk factors are readily modifiable.

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Outcome of a single XEN microstent implant for glaucoma patients with different types of glaucoma

Cited by 4 publications

References 19 publications

Two-Year Outcome of Surgery in Glaucoma Patients

Two-Year Outcome of Surgery in Glaucoma Patients

Implantation of XEN After Failed Trabeculectomy: an Efficient Therapy?

Normal‐tension glaucoma: Current concepts and approaches‐A review

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