Review of the Xen Gel Stent and InnFocus MicroShunt

Green, Wesley; Lind, John T.; Sheybani, Arsham

doi:10.1097/icu.0000000000000462

Cited by 46 publications

(33 citation statements)

References 26 publications

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“…The surgical procedure is generally performed under indirect observation using a 45°gonioscopic lens according to the surgeon's experience. The surgeon marks the intended area of placement in the supero-nasal quadrant, which is 3 mm from the limbus [22,23]. The Xen 45 Gel stent should be implanted anterior to Schlemm's canal in order to avoid blood reflux into the AC that could occur by needle passage through the above mentioned canal.…”

Section: Xen 45 Gel Stentmentioning

confidence: 99%

In vivo confocal microscopy: qualitative investigation of the conjunctival and corneal surface in open angle glaucomatous patients undergoing the XEN-Gel implant, trabeculectomy or medical therapy

et al. 2020

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Purpose: Assessing the quality of the ocular surface by in vivo scanning laser confocal microscopy (IVCM) in primary open angle glaucoma (POAG) patients treated by Xen 45 Gel Stent, medical therapy and trabeculectomy. Methods: Retrospective, single-center, single-masked, comparative study including 60 eyes of 30 patients (mean age 61.16 ± 10 years) affected by POAG. Eyes were divided into 3 groups: Group 1 eyes underwent the Xen 45 Gel Stent procedure, Group 2 eyes were under medical therapy, Group 3 eyes were surgically treated by trabeculectomy. All patients underwent HRT II IVCM analysis of cornea, limbus, conjunctiva, sub-tenionian space and sclera. Results: The Xen 45 Gel stent, if properly positioned in the sub-conjunctival space preserves goblet cells and limits ocular surface inflammation. Regular corneal epithelial cells with micro-cysts, and normo-reflective sub-epithelial nerve plexus are documented by IVCM. In sub Tenon's implants an alternative lamellar intra-scleral filtration is detectable. Combined surgical procedures show a noticeable number of inflammatory cells with rare micro-cysts. Post-trabeculectomy inflammatory reaction is more evident than Xen 45 Gel Stent associated surgical procedures, but less than medical therapy where a conspicuous presence of Langerhans cells, peri-neural infiltrates, marked loss of goblet cells and fibrosis is visible. Conclusion: Ocular surface inflammation was more notable in topical therapy than after trabeculectomy, which itself causes more inflammation than XEN Gel stents.

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Section: Xen 45 Gel Stentmentioning

confidence: 99%

In vivo confocal microscopy: qualitative investigation of the conjunctival and corneal surface in open angle glaucomatous patients undergoing the XEN-Gel implant, trabeculectomy or medical therapy

et al. 2020

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“…This is likely to explain why initial studies suggest they are less efficacious than these procedures but with a lower rate of hypotony related complications. The XEN implant (Allergan, Dublin, Ireland) and the Innfocus Microshunt (Santen Pharm Ltd, Osaka, Japan), result in subconjunctival drainage and therefore offer the possibility of achieving intraocular pressure (IOP) similar to trabeculectomy but, as they have less scleral and conjunctival manipulation, with a more rapid recovery time and less complications [4]. The evidence for these procedures, however, remains limited.…”

Section: Introductionmentioning

confidence: 99%

1-year outcomes of the Xen45 glaucoma implant

Smith

Charles

Abdel-Hay

et al. 2018

Eye

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Objectives To describe the 12-month outcomes of the Xen45 glaucoma stent. Methods Non-comparative retrospective study of all cases who underwent Xen glaucoma surgery in April 2017 or earlier and completed 12 months of follow-up. The primary outcome measures were intraocular pressure (IOP) reduction and number of glaucoma medications at 12 months postoperatively. The secondary outcome measures were surgical complications and the success rate of surgery at 1 year. Success rate was defined according to the multiple IOP thresholds of 15 mmHg, 18 mmHg, and 21 mmHg with all requiring a drop of 20% and no additional glaucoma surgery. Revision or needling of the Xen conjunctival bleb was not considered to constitute a surgical failure. Results Sixty-eight eyes were included in the study. Mean IOP dropped from 22.1 mmHg preoperatively to 14.8 mmHg at 12 months, a 33% drop (p < 0.0001). Mean number of glaucoma medications reduced from 2.9 preoperatively to 1.1 at 12 months (p < 0.0001). In total, 54.4% of cases were back on glaucoma medications by 12 months. Success rate varied from 32.4% when defined as IOP ≤ 15 mmHg and ≥ 6 mmHg and ≥ 20% reduction without medications to 70.6% when defined as IOP ≤ 21 mmHg and ≥ 6 mmHg and ≥ 20% reduction with or without medications. Thirty cases (44.1%) required bleb needling or surgical revision. Conclusions The Xen45 is effective at reducing IOP and glaucoma medication use at 12 months postoperatively. Patients considering this procedure should be warned that by 12 months postoperatively there is a significant chance of requiring postoperative bleb intervention and glaucoma drops.

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“…A dose of 20-40 mcg can be injected into the subconjunctival/sub Tenon's space just posterior to the implant site either before or after stent implantation. [8] 3. The main corneal incision and paracentesis are created in the appropriate quadrant, depending on the eye and dexterity of the surgeon.…”

Section: Surgical Techniquementioning

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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Review of the Xen Gel Stent and InnFocus MicroShunt

Abstract: Early data with the XEN Gel Stent and InnFocus MicroShunt show promising results. Prospective comparative studies comparing these devices with tube shunt and trabeculectomy will be needed.

Cited by 46 publications

References 26 publications

In vivo confocal microscopy: qualitative investigation of the conjunctival and corneal surface in open angle glaucomatous patients undergoing the XEN-Gel implant, trabeculectomy or medical therapy

In vivo confocal microscopy: qualitative investigation of the conjunctival and corneal surface in open angle glaucomatous patients undergoing the XEN-Gel implant, trabeculectomy or medical therapy

1-year outcomes of the Xen45 glaucoma implant

XEN Gel stent: A Review

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