Six month outcomes of solo XEN and combined phaco-XEN in a district hospital setting in UK

Session Details

Session Title: Glaucoma

Session Date/Time: Monday 09/10/2017 | 08:00-10:30

Paper Time: 09:06

Venue: Room 4.1

First Author: : J.van der Hoek UK

Co Author(s): :    M. Blizzard                    

Abstract Details

Purpose:

The Xen Gel Stent implantation is a novel minimally invasive technique used in the treatment of primary open angle glaucoma. It is inserted via an ab-interno procedure to create a sub-conjunctival flow of aqueous. Implantation of a Xen Gel Stent is commonly combined with phaco-emulsification for combined treatment of cataract and glaucoma. The limited available literature suggests that there is no difference in the proportion of successful outcomes of phaco- xen compared to solo Xen implantation This work aimed to monitor and assess the outcomes achieved with the adoption of this new procedure and compare combined and solo procedures.

Setting:

This work was performed by the glaucoma team of the ophthalmology department of Scarborough General Hospital, a regional secondary referral centre in the north of England, United Kingdom serving a mainly rural population of 260.000 people.

Methods:

Outcome data from 56 Xen insertions was collected retrospectively from April 2016 to March 2017 at Day 1 (D1) , Month 1, 3, 6 and 12 (M1, M3, M6, M12) using a specially adapted computer database. The primary outcomes were IOP & need for topical glaucoma treatment. Patients were assigned to four outcome groups allowing production of Kaplan-Meier survival curves.
 “Success” was >20% IOP reduction without topical pressure lowering treatments. 
“Qualified success” was >20% IOP reduction with ongoing topical treatments
“Maintained” was IOP <22mmHg without topical treatments. 
“Failure” was IOP >22mmHg The number of complications and additional procedures was also collected.

Results:

Data was collected on 56 consecutive procedures; Mean age was 74.3 (43-92), 28/56 female, 38 phaco-xen, mean pre-op IOP 23.6 (13-48); 18 solo-xen, mean pre-op IOP 25.2 (17-40); Mean IOP was reduced to 16.9 mmHg in phaco-xen and 15.3 mmHg in solo-xen at M6. 40% achieved ‘success’ and 65% qualified at M6 in phaco-xen. 69% had success and 76% qualified in solo-xen. 63% of solo-Xen and 40% of phaco-xen had IOP<15mmHg at M3. 2 patients had transient hypotony. Further interventions were performed on 10 eyes (17.5%); Topical medications were reduced from mean 2.4 pre-op and 0.2 at M3.

Conclusions:

Our early ‘real world’ clinical outcomes show good reductions in IOP and use of medication albeit with lower success rates than shown in published data. Although Xen placement is a convenient operation to combine with cataract surgery our data suggest that combining phaco with Xen produces less effective IOP lowering than Xen alone.

Financial Disclosure:

NONE