Trabeculectomy versus Xen gel implant for the treatment of open-angle glaucoma: a 3-year retrospective analysis

Cappelli, Francesca; Cutolo, Carlo Alberto; Olivari, Sara; Testa, Valeria; Sindaco, Daniele; Pizzorno, Chiara; Ciccione, Sara; Traaverso, Carlo Enrico; Iester, Michele

doi:10.1136/bmjophth-2021-000830

Cited by 18 publications

(18 citation statements)

References 17 publications

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“…In a 24-month retrospective study, patients in the Xen 45 group experienced a significantly lower incidence of wound leak (0% vs. 15.8%), bleb leak (0% vs. 6%), and hypotony (1.8% vs. 10.5%) compared to trabeculectomy [ 17 ], and a retrospective study comparing trabeculectomy with Xen implant, both in combination with phacoemulsification, reported a higher incidence of hypotony after trabeculectomy (7.7% vs. 0%) [ 33 ]. In two retrospective Xen vs. trabeculectomy studies, the incidence of hypotony was not reported; however, the anterior chamber flattening, a condition commonly related to hypotony, was greatly more frequent in the trabeculectomy compared to the Xen group (19.6% vs. 1.5% and 14.7% vs. 0%, trabeculectomy vs. Xen, respectively) [ 34 , 35 ]. In one study, no late hypotony and hypotony maculopathy occurred after the first month of follow-up [ 36 ], and one study reported a similar incidence of choroidal folds and hypotony maculopathy in the two groups (hypotony maculopathy 1.1% Xen, trabe 0.6%) [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Ab Interno XEN 45 Gel Stent in Patients with Glaucoma and High Myopia

Sacchi

Fea

Monsellato

et al. 2023

JCM

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This study reports on the safety and efficacy of Xen 45 in patients with glaucoma and high myopia. It was a retrospective study including patients with high myopia (>6D) who underwent Xen implant with 2 years of follow-up. The primary outcome was to report the incidence of hypotony (IOP ≤ 5 mmHg) and hypotony-related complications. Patients with high myopia treated with mitomycin-C-augmented trabeculectomy were included as a control group. We included 14 consecutive patients who underwent Xen implant (seven eyes) and trabeculectomy (seven eyes). The mean myopia was −14.71 ± 5.36 and −15.07 ± 6.11 in the trabeculectomy and Xen groups, respectively (p > 0.05). The success rate and the mean IOP at 1 and 2 years from the intervention were statistically comparable between the two groups. The group undergoing trabeculectomy showed a higher incidence of hypotony (six eyes (85.71%) vs. two eyes (28.57%)) and hypotony maculopathy (three eyes (42.86%) vs. zero eyes (0%)) and required more postoperative procedures. Patients with high myopia were at higher risk of hypotony-related complications after trabeculectomy. The Xen implant can achieve an IOP control comparable to trabeculectomy with a significantly better safety profile and can be considered as an option for the management of patients with high myopia and glaucoma.

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Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Ab Interno XEN 45 Gel Stent in Patients with Glaucoma and High Myopia

Sacchi

Fea

Monsellato

et al. 2023

JCM

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“…Due to its efficacy in treating normal-tension glaucoma (NTG) and achieving low intraocular pressure in patients with advanced glaucoma, the use of trabeculectomy is important and will likely persist. Trabeculectomy also offers better IOP lowering compared to the Xen 45 Gel stent [61].…”

Section: Trabeculectomymentioning

confidence: 99%

Refractive Lensectomy and Microinvasive Glaucoma Surgery (MIGS): An Initial Approach in Glaucoma Patients over 50 Years of Age

Laroche¹,

Rickford²

2022

Refractive Surgery - Types of Procedures, Risks, and Benefits

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Glaucoma is a common cause of blindness worldwide, affecting patients at an average age of 57 years old. This is a disease of ocular anatomy commonly caused by a blockage of trabecular meshwork leading to an increase in intraocular pressure and glaucomatous optic neuropathy. The lens enlarges in width with age, often contributing to this, with obstruction of the angle due to pupillary block in angle-closure glaucoma. In open-angle glaucoma, there is often increased pigment liberation and obstruction of the trabecular meshwork due to increased iridolenticular and zonular contact. Recent studies looking at cataract extraction, refractive lensectomy, and the Hydrus stent have demonstrated adequate safety and efficacy for the treatment of glaucoma. We review the latest glaucoma treatment algorithm and results with early cataract surgery/refractive lensectomy and microinvasive glaucoma surgery to be considered as initial treatment for patients with glaucoma over 50 years of age.

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“…[22][23][24] In addition, the information about the long-term effect of XEN45 device is limited, with only few papers evaluating its effectiveness beyond 24 months. 17,[25][26][27][28][29] Moreover, the question of whether there are any differences in IOP lowering or reduction of ocular hypotensive medications between XEN alone or in combination with phacoemulsification in the long-term remain.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Effectiveness of XEN 45 Gel-Stent in Open-Angle Glaucoma Patients

Marcos-Parra¹,

Salinas-López²,

Mateos-Marcos³

et al. 2023

OPTH

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To assess the effectiveness of XEN45, either alone or in combination with phacoemulsification, in open-angle glaucoma (OAG) patients in clinical practice. Methods: Retrospective and single-center study conducted on OAG patients who underwent XEN45 implant, either alone or in combination with cataract surgery. We compared the clinical outcomes of the eyes of thosewho underwent XEN-solo versus those who underwent XEN+Phacoemulsification. The primary endpoint was the mean change in intraocular pressure (IOP) from baseline to the last follow-up visit. Results: A total of 154 eyes, 37 (24.0%) eyes that underwent XEN-solo and 117 (76.0%) eyes that underwent XEN +Phacoemulsification, were included. The mean preoperative IOP was significantly lowered from 19.1±5.0 mmHg to 14.9±3.8 mmHg at month-36, p<0.0001. Preoperative IOP was significantly lowered from 21.2±6.2 mmHg and 18.4±4.3 mmHg to 14.3 ±4.0 mm Hg and 15.2±3.7 mmHg at month-36 in the XEN-solo and XEN+Phacoemulsification groups, p<0.0004 and p=0.0009; with no significant differences between them. In the overall study population, the mean number of antiglaucoma medications was significantly reduced from 2.1±0.8 to 0.2±0.6, p<0.0001. There were no significant differences in the proportion of eyes with a final IOP ≤14 mmHg and ≤16 mmHg between XEN-solo and XEN+Phaco groups (p=0.8406 and 0.04970, respectively). Thirtysix (23.4%) eyes required a needling procedure. Conclusion: XEN implant significantly lowered IOP and reduced the need of ocular hypotensive medication, while maintaining a good safety profile. Beyond week-1, there were no significant differences in IOP lowering between XEN-solo and XEN +Phacoemulsification groups.

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Trabeculectomy versus Xen gel implant for the treatment of open-angle glaucoma: a 3-year retrospective analysis

Cited by 18 publications

References 17 publications

Safety and Efficacy of Ab Interno XEN 45 Gel Stent in Patients with Glaucoma and High Myopia

Safety and Efficacy of Ab Interno XEN 45 Gel Stent in Patients with Glaucoma and High Myopia

Refractive Lensectomy and Microinvasive Glaucoma Surgery (MIGS): An Initial Approach in Glaucoma Patients over 50 Years of Age

Long-Term Effectiveness of XEN 45 Gel-Stent in Open-Angle Glaucoma Patients

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