Posters

Is a Day 1 postop review following Xen surgery needed?

Poster Details

First Author: A.Karimi UK

Co Author(s):    D. Lindfield                    

Abstract Details

Purpose:

Case series data show that the Xen (Allergan Inc.) stent, a minimally invasive glaucoma surgical device (MIGS), has a lower rate of visually threatening complications than trabeculectomy. Typically, follow up for Xen surgery has been at Day 1, Week 1, Month 1, 3, 6, 9 and 12. Routine first day IOP check has been abandoned for phacoemulsification for several reasons that could also apply to MIGS. With low complication rates, improved postoperative outcomes and economical constraints, is a Day 1 follow up required following routine Xen surgery?

Setting:

Retrospective notes review of 259 Xen surgeries across four centres.

Methods:

All cases were: performed by consultant ophthalmic surgeons with a special interest in glaucoma; augmented with 0.1mL of Mitomycin C at 0.2mg/mL; given standardised postoperative antibiotic and steroid drops, with discontinuation of glaucoma medications at surgery.

Results:

No correlation was found between Day 1 IOP and Week 1 (r2=0.2155), Month 1 (r2=0.0574) and Month 12 (r2=0.1580). 78 of 259 cases had IOP<6mmHg on Day 1, but only 2 cases required active AC reformation, both after Day 1. 1 case (0.4%) required glaucoma drops at Day 1 – this was a high-risk case with uncontrolled IOPs despite Acetazolamide and drops pre-op. 1 case (0.4%) had iris occlusion as the stent was placed too posteriorly (noted intraoperatively), therefore required stent manipulation at Day 1. All other complications and interventions occurred a Week 1 or beyond.

Conclusions:

With increasing pressures on healthcare and growing workloads, a reasonable balance of postoperative reviews needs to be achieved. 99.2% of cases in our series did not require intervention at Day 1. The 2 cases (0.8%) that needed intervention were identified as high-risk cases pre- or intra- op. Day 1 IOP did not show correlation with Week 1, Month 1 or 12 IOP. It may be more effective to have the first postop review for Xen at Week 1. Day 1 review may be discarded for routine cases (reserved for high-risk).

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented