XEN Gel Stent in the management of primary open-angle glaucoma

Post, M.H.; Lubiński, Wojciech; Śliwiak, Dominik; Podborączyńska–Jodko, Karolina; Mularczyk, Maciej

doi:10.1007/s10633-020-09753-4

Cited by 16 publications

(24 citation statements)

References 33 publications

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“…Among 58 studies that recorded a minimum of 12 months of follow-up, the postoperative weighted mean IOP was 13.6 mm 4,5,12,15,16,[19][20][21][22]72 In all three groups of studies, the weighted mean average number of postoperative medications was less than 1. The results were similar for a second analysis in which studies were clustered in terciles from lowest mean baseline IOP to highest: First 19 studies (range, 15.3-21.0 mm Hg), 4,10,12,21,22,26,32,35,37,41,[46][47][48]50,54,60,61,65,68 second 20 studies (range, 21.1-23.4 mm Hg), 24,28,30,31,33,34,38,40,[42][43][44][45]53,55,57,58,[62][63]…”

Section: Interpretationssupporting

confidence: 58%

“…In 18 prospective studies representing a total of 1591 eyes, a median of 53 eyes (range, 12-221) were followed for a median of 12 months (range, 8-36). 5,10,11,15,21,22,29,31,37,40,43,44,50,54,55,58,63,69 In 41 retrospective studies representing 3111 total eyes, a median of 52 eyes (range, 13-242) were followed for a median of 12 months (range, 6-36). 4,12,16,19,20,[24][25][26][27][28]30,[32][33][34][35][36]38,39,41,42,[45][46][47][48][49][51][52][53][56][57][58][59]…”

Section: Efficacy Outcomesmentioning

confidence: 99%

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Intraocular Pressure and Medication Changes Associated with Xen Gel Stent: A Systematic Review of the Literature

Panarelli¹,

Vera²,

Sheybani³

et al. 2023

OPTH

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The Xen gel stent (Allergan Inc, an AbbVie company; Dublin, Ireland) was conceived as an option for patients requiring modest IOP reduction but for whom trabeculectomy was not yet indicated. As with any glaucoma surgery, establishing criteria for patient selection and identifying factors that contribute to a high likelihood of success are important. To help guide clinical decisionmaking, a systematic review of published studies on the gel stent was performed, with the goal of understanding postoperative outcomes based on clinical and patient factors. Results were organized around a series of pertinent clinical questions based on scenarios encountered in clinical practice. Criteria for including studies were intentionally broad, with the objective of simulating the diverse population of glaucoma patients encountered in real-world practice. Outcomes for IOP and medication reduction postoperatively were assessed in various analyses, including in eyes with various glaucoma types and severity; in eyes naïve to surgery as well as those with a history of prior incisional glaucoma surgery; and when surgery was performed as a standalone procedure or at the time of cataract surgery. The results of each of the various analyses were consistent in demonstrating that successful gel stent surgery achieved a postoperative IOP of approximately 14.0 mm Hg and reduction to fewer than 1 glaucoma medication. Additional data are shown on outcomes by method of implant (ab interno vs ab externo); intraoperative use of antifibrotics; and rates of needling in published studies.

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Section: Interpretationssupporting

confidence: 58%

Section: Efficacy Outcomesmentioning

confidence: 99%

Intraocular Pressure and Medication Changes Associated with Xen Gel Stent: A Systematic Review of the Literature

Panarelli¹,

Vera²,

Sheybani³

et al. 2023

OPTH

View full text Add to dashboard Cite

show abstract

“…In most studies, the proportion of IOP decreases was >30%. Only 6 studies reported that IOP decreased by <20% (24,30,31,35,49,66). A common feature was found among these studies, which was that the baseline IOP was at a relatively low level of <22 mmHg.…”

Section: Decreasing Iop and Reducing Antiglaucoma Medicationsmentioning

confidence: 99%

“…Cases of stent malposition needed to remove or reimplant of the stent (12). Bleb-related complications comprised bleb leakage (0.68%) and dysesthetic blebs (0.01%) that required sutures (34,53) or revisions (15,35,75).…”

Section: Complicationsmentioning

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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“…1,2 The stent creates an outflow tract for aqueous humor to drain into the subconjunctival space, where it forms a bleb. 1 Mitomycin-C (MMC) is often used in XEN Gel Stent surgery and can be associated with a number of postoperative complications including: hypotony, 3,4 IOP spikes or chronic IOP rise, 3 hyphaema, 4 endophthalmitis, 5 blebitis, 3 persistent anterior chamber inflammation, cystoid macular edema, fibrin formation, 1 fibrosis, 6 and frequent need for postoperative maneuvers. 3 This is, to our knowledge, the first reported case of surgically induced necrotizing scleritis (SINS).…”

mentioning

confidence: 99%

Infective Necrotizing Scleritis After XEN Gel Stent With Mitomycin-C

Kingston

Zagora

Symes

et al. 2021

Journal of Glaucoma

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The purpose of this study was to report a case of infective necrotizing scleritis following XEN Gel Stent with mitomycin-C.Methods: Case report. This is a case report of a 68-year-old woman.Results: XEN Gel Stent glaucoma surgery enhanced with mitomycin-C 0.04% and combined with cataract surgery was performed at a regional center to manage the patient's primary open-angle glaucoma. Past medical history was significant for rheumatoid arthritis requiring treatment with methotrexate and adalimumab. Periocular pain and swelling developed 14 months after the initial operation, followed by a rapid deterioration of visual acuity to 20/60, intraocular pressure of 4 mm Hg, and worsening pain 5 months later. On initial presentation to Sydney Eye Hospital, 180 degrees of scleral necrosis was evident with a moderate anterior segment inflammatory reaction and a large temporal choroidal effusion due to hypotony. Empirical hourly topical ofloxacin and cephalothin 5% drops, with oral moxifloxacin, were initiated. Conjunctival swab grew Staphylococcus aureus and Staphylococcus lugdunensis. Significant clinical improvement occurred, but the XEN Gel Stent became exposed after 9 days of treatment with worsening hypotony. Urgent surgical revision was performed to remove the XEN Gel Stent and apply a tutoplast plug with overlying amniotic membrane graft. Intraocular pressure gradually improved over 6 weeks to 15 mm Hg with reversal of hypotonous changes, and visual acuity stabilized at 20/40.Conclusions: To our knowledge, this is the first reported case of necrotizing scleritis following XEN Gel Stent insertion. It is a reminder that infection should always be the primary differential diagnosis in patients with surgical-induced necrotizing scleritis.

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XEN Gel Stent in the management of primary open-angle glaucoma

Cited by 16 publications

References 33 publications

Intraocular Pressure and Medication Changes Associated with Xen Gel Stent: A Systematic Review of the Literature

Intraocular Pressure and Medication Changes Associated with Xen Gel Stent: A Systematic Review of the Literature

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

Infective Necrotizing Scleritis After XEN Gel Stent With Mitomycin-C

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