XEN Gel Stent Open Conjunctiva Technique: A Practical Approach Paper

Panarelli, Joseph F.; Yan, David; Francis, Brian A.; Craven, E. Randy

doi:10.1007/s12325-020-01278-1

Cited by 34 publications

(55 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Bleb morphology is likely the main contributor to overall outflow resistance and thus determines the IOP one can achieve with XEN Gel Stents. 25 , 26 , 27 Bleb efficacy is inversely related to the wound-healing response, which is more robust in Asian patients, including the Japanese patient in this case. 29 While XEN Gel Stents were originally studied using an ab interno approach, 21 , 23 , 24 in this case we chose an ab externo, open-conjunctival approach, which has gained popularity recently due to several key advantages.…”

Section: Discussionmentioning

confidence: 66%

“… 29 While XEN Gel Stents were originally studied using an ab interno approach, 21 , 23 , 24 in this case we chose an ab externo, open-conjunctival approach, which has gained popularity recently due to several key advantages. 27 Most importantly for NTG patients, this approach allows for consistent sub-Tenon's stent placement, which has been shown to result in greater IOP reduction. 30 The mechanism for greater IOP reduction of sub-Tenon's placement is unknown, though perhaps the scleral vasculature is more effective at draining fluid or the healing response in the sub-Tenon's space is more conducive for developing diffuse posterior blebs that facilitate better drainage.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, Tenon's can be separated from the episclera creating a pocket of space to shape bleb morphology and ensure the stent is free and mobile. 27 , 31 Thus, the ab externo open-conjunctival approach may offer improved bleb function and better IOP reduction capability, which is especially important for NTG patients with low IOP requirements. Additionally, the ab externo open-conjunctival approach does not require corneal incisions or instrumentation in the anterior chamber except for the Xen Gel Stent injector itself, making it theoretically safer in phakic eyes and offering the surgeon more flexibility in adjusting the stent's precise depth in the anterior chamber.…”

Section: Discussionmentioning

confidence: 99%

“… 18 , 21 , 22 , 23 , 24 It has been suggested that this discrepancy is due to additional outflow resistance of a suboptimal conjunctival bleb created following ab interno implantation. 25 , 26 In contrast, an ab externo approach offers the opportunity to dissect Tenon's from the episclera and optimize stent positioning, 27 which may allow for better bleb morphologies that can achieve lower IOPs closer to the theoretic limit. While no clinical studies have directly compared ab externo and ab interno implantation of XEN Gel Stents, 28 anecdotally, clinicians have noted lower IOPs and better bleb morphologies with an ab externo approach.…”

Section: Introductionmentioning

confidence: 99%

“…While no clinical studies have directly compared ab externo and ab interno implantation of XEN Gel Stents, 28 anecdotally, clinicians have noted lower IOPs and better bleb morphologies with an ab externo approach. 27 Thus for NTG, modifications to the XEN Gel Stent implantation procedure including an ab externo approach may produce better-functioning blebs with IOPs closer to the theoretical minimum that could effectively treat NTG.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Effective treatment of a normal-tension glaucoma patient with bilateral ab externo XEN Gel Stent implantation

Harris

Valle

2020

American Journal of Ophthalmology Case Reports

View full text Add to dashboard Cite

Purpose To provide the first report of effective use of bilateral XEN Gel Stent implantation using an ab externo open-conjunctival approach designed to improve bleb function and meet the uniquely low intraocular pressure requirements of a Japanese patient with normal-tension glaucoma refractory to topical medical therapy. Observations A 54-year-old phakic Japanese woman with severe normal-tension glaucoma on maximally tolerated medical therapy of four topical agents presented with above-goal intraocular pressures and new medication intolerances. She underwent bilateral ab externo open-conjunctival XEN Gel Stent implantation with tenectomy and sub-Tenon's injection of 40μg of mitomycin-C, which resulted in reduction of intraocular pressures by 41.2 and 28.6% to 10 and 10 mmHg in the right and left eyes, respectively at the most recent visit. Postoperatively, a diffuse filtering bleb with good morphology developed in both eyes. The procedure has so far allowed for complete cessation of all four topical medications for up to eight months following surgery without any serious complications. Conclusions This case illustrates the potential of Xen Gel Stent implantation through an ab externo, open-conjunctival approach to be an effective, simple alternative to trabeculectomy to meet the unique low-pressure requirements of normal-tension glaucoma patients with practical and safety benefits of a micro-invasive approach.

show abstract

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Effective treatment of a normal-tension glaucoma patient with bilateral ab externo XEN Gel Stent implantation

Harris

Valle

2020

American Journal of Ophthalmology Case Reports

View full text Add to dashboard Cite

show abstract

Defining the role of ab externo Xen gel stent in glaucomatous eyes with prior failed surgical intervention

Dhoot

Chuang

et al. 2022

Graefes Arch Clin Exp Ophthalmol

View full text Add to dashboard Cite

Purpose To evaluate the safety and efficacy of Xen45 Gel stent (Xen; Allergan) in eyes that have failed prior surgical intervention, compared to traditional glaucoma drainage device (GDD) or continuous-wave cyclophotocoagulation (CPC). Since this population has low expected success rates with additional surgery, it is vital to compare to standard-of-care surgical options. Methods Retrospective, single-center, case–control study of ab externo transconjunctival Xen shunt in eyes that have previously undergone trabeculectomy and/or GDD surgery. Postoperative data were collected for 18 months. Failure was defined as no light perception, additional glaucoma surgery required, or intraocular pressure (IOP) of < 6 mmHg after 6 weeks postoperatively. Results Eighteen Xen eyes and 36 control eyes matched on both glaucoma type and previous glaucoma surgeries were included. Seventy-two percent had primary open angle glaucoma, 11% uveitic, 6% primary angle closure, 6% pseudoexfoliation, and 6% pigmentary glaucoma. Fifty-six percent of eyes in each group had prior trabeculectomy, 28% of Xen and 31% of control eyes had prior GDD, and 17% of Xen and 14% of control eyes had both. Baseline medicated IOP was lower in the Xen group (21.8 ± 7.2) compared to controls (27.5 ± 9.4, P = 0.043). The cumulative failure rate at year 1 was 17% for Xen and 20% for controls (P = 0.57). Mean survival time was 14.1 (± 1.5) months and 11.4 (± 0.6) months for controls. There was no difference in minor complication rates between groups (P = 0.65), but the Xen group had a significantly lower rate of serious complications (P = 0.043) defined as vision threatening or requiring surgical intervention in the operating room. When censored for additional glaucoma procedures, there were no differences at year 1 in IOP, change in IOP, number of IOP-lowering medications, or number of medications reduced from baseline. Conclusions The Xen shunt provides a reasonable alternative to current standard of care, with a similar failure rate at year 1, with a noninferior IOP reduction compared to GDD and CPC, and a preferred safety profile.

show abstract

Reoperations for complications within 90 days after gel stent implantation or trabeculectomy

et al. 2022

View full text Add to dashboard Cite

Purpose To describe reoperations in the operating room for complications that occurred within the first 90 days after gel stent implantation or trabeculectomy at a single institution over 5 years. Methods In this retrospective chart review, patients who have undergone gel stent implantation with mitomycin C (MMC) or trabeculectomy with MMC were enrolled. Postoperative complications that required reoperations within the first 90 days were evaluated. Results A total of 510 surgeries were performed on 392 patients over a 57-month period by 2 glaucoma surgeons. Of these, 284 were gel stent implantation, and 226 were trabeculectomy. Combined phacoemulsification was performed in 52/284 (18.3%) in the gel stent group and in 26/226 (11.5%) of eyes in the trabeculectomy group (p = 0.03). Reoperations took place in 13/510 (2.5%) eyes, including 4/284 (1.4%) in the gel stent group, 9/226 (4.0%) in the trabeculectomy group (p = 0.07). In the gel stent group, indications for reoperation were bleb failure (2), suprachoroidal hemorrhage (1), bullous keratopathy (1). In the trabeculectomy group, indications for reoperation were bleb failure (3), overfiltration (2), persistent wound leak (2), aqueous misdirection (2). Conclusions The rates of reoperation for early postoperative complications after gel stent or trabeculectomy was low and comparable with previous studies. A slightly higher number of reoperations within 90 days was observed in the trabeculectomy group than the gel stent group despite the more significant number of combined procedures in the latter group. Bleb failure was the most common indications for reoperation in both groups. Excessive outflow was a cause of reoperation mostly in the trabeculectomy group.

show abstract

XEN Gel Stent Open Conjunctiva Technique: A Practical Approach Paper

Cited by 34 publications

References 14 publications

Effective treatment of a normal-tension glaucoma patient with bilateral ab externo XEN Gel Stent implantation

Effective treatment of a normal-tension glaucoma patient with bilateral ab externo XEN Gel Stent implantation

Defining the role of ab externo Xen gel stent in glaucomatous eyes with prior failed surgical intervention

Reoperations for complications within 90 days after gel stent implantation or trabeculectomy

Contact Info

Product

Resources

About