XEN glaucoma treatment system in the management of refractory glaucomas: a short review on trial data and potential role in clinical practice

Abstract

The recent development of new devices that are significantly less invasive, collectively termed minimally invasive glaucoma surgery, offers new perspective of intraocular pressure reduction with less risk, short operating times, and rapid recovery. The aim of this work is to provide a panoramic review of the currently published clinical data to assess the potential role of XEN gel stent (Allergan PLC, Irvine, CA, USA) in the management of glaucoma, which is the only filtering minimally invasive glaucoma surgery device that allows the subconjunctival filtration. The ab interno placement of the XEN gel stent offers an alternative for lowering intraocular pressure in refractory glaucoma as a final step, and in patients intolerant to medical therapy as an early surgical approach with minimum conjunctival tissue disruption, restricted flow to avoid hypotony, and long-term safety.

Safety and efficacy outcomes of the Xen45 Gel Stent use for refractory glaucoma: a surgery series from surgeon trainees at a tertiary teaching hospital

“…The studies had an antiglaucoma medication class reduction range from 51.4 to 94.6% [4][5][6][7][8][9][10]. The trainees in our study had a 65.8% decrease in the number of classes for the 15 patients with 12-month follow-up, which fell within the range of what was previously reported.…”

“…There have been several noncomparative prospective and retrospective studies [6][7][8][9][10][11][12][13][14][15] with consistent studyto-study trends even though the ranges for those effects varied broadly. In general, subjects' IOPs started at a baseline in the low 20s and decreased to the low and mid-teens by the end of the first year from XEN45 Gel Stent placement.…”

“…Given its relatively recent appearance on the market (FDA approval on November 21, 2016), the XEN45 MIGS procedure is not as commonly performed as incisional or other available MIGS procedures. The first prospective studies started with examination of the larger XEN63 and XEN140 devices [4,5] and since then there have been prospective [6][7][8][9][10][11] and retrospective [12][13][14][15] studies examining the safety and efficacy of XEN45 Gel Stent placement. Overall, the consensus is that the XEN45 is effective in lowering IOP in patients with open angle glaucoma over the course of 12 months [16].…”

“…Overall, the consensus is that the XEN45 is effective in lowering IOP in patients with open angle glaucoma over the course of 12 months [16]. Complications are usually transient and mild to moderate in severity, with transient hypotony being the most commonly noted adverse event [4,[6][7][8]. Fortunately, complications are rare, although a suprachoroidal hemorrhage had been reported as a case study [17].…”

“…Fortunately, complications are rare, although a suprachoroidal hemorrhage had been reported as a case study [17]. Stent failures required secondary surgical intervention and/or explantation [5][6][7][8][9]. All studies reported averages of > 20% reduction in IOP, and found needling to be a common intervention for bleb management [5][6][7][8][9][10].…”