XEN stents: one year efficacy and experience in the management of this novel device

Session Details

Session Title: Presented Poster Session: Glaucoma II

Venue: Poster Village: Pod 3

First Author: : A.Ansari UK

Co Author(s): :    B. Karri   D. Mathews                    

Abstract Details

Purpose:

The XEN stent is classed under the umbrella term Minimally Invasive Glaucoma Surgery (MIGS) as it is thought to be less invasive, reduce surgical time and post-operative infection rates compared with traditional glaucoma procedures. It is positioned in the subconjunctival/ sub-tenons space, via an ab interno approach through the anterior trabecular meshwork allowing aqueous drainage via the unconventional pathway with improved pressure reduction compared to schlemms canal positioned MIGS devices We aimed to evaluate the safety and efficacy of the XEN45 Gel Stent (XEN stent) evaluating variances in Combined (Phaco-xen) and Xen alone outcomes.

Setting:

Stanley Eye Unit, Abergele, United Kingdom

Methods:

A retrospective, consecutive case series of all eyes treated with isolated XEN stent (XEN) or combined with cataract surgery (phaco-XEN) was conducted. The outcomes evaluated included IOP, effect on anti-glaucoma medications, complications and success, deemed a reduction in IOP≥20% from listing pressure. Data was analysed using a two-tailed T-test and Analysis of Variance (ANOVA).

Results:

55 XEN stent procedures were performed in 50 patients over 6-18 months with phaco-XEN in 27 eyes and XEN in 28 eyes. Success (IOP≥20% reduction from preoperative level) amongst the XEN group at 1 year was 50% and phaco-XEN was 47%.  IOP was reduced preoperatively from 21.1 to 16.7 postoperatively. Subgroup analysis demonstrated an IOP reduction from 22.6mmHg to 17.6mmHg in the XEN and 19.6mmHg to 16.1mmHg in the phaco-XEN at 1 year.  A statistically significant reduction(P<0.01) in postoperative IOP was achieved at almost all time points over one year of follow-up for both subgroups.

Conclusions:

5(9%) eyes had intraoperative complications. 16(29%) developed postoperative complications including 1 person with endophthalmitis. 33(60.0%) eyes required no needling. Additionally 15(27.3%) needed at least 1 other procedure in theatre. The surgical technique is evolving so the efficacy will likely improve. There is a significant proportion that will require postoperative manipulation and patients need to be forewarned.

Financial Disclosure:

None