Outcomes of XEN-45 Gel Stent in Open-Angle Glaucoma using the PoST Technique: 12-month Follow-up

Date
2023
Authors
Liu, Angela
Dhar, Lauren
Hung, Sarah
Fellman, Ronald
Grover, Davinder
ORCID
0000-0001-7902-538X (Liu, Angela)
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Abstract

Purpose: The purpose of this study was to report the 12-month surgical outcomes of the novel PoST technique (Posterior Sweep of Tenon’s technique) in eyes undergoing glaucoma surgery with the XEN-45 Gel Stent.

Methods: A retrospective review was performed for patients who underwent ab interno implantation of a XEN-45 Gel Stent using the PoST technique with or without concurrent cataract surgery. The surgery was performed in adults with open-angle glaucoma that was refractory to prior surgical treatment and glaucoma medications.

Results: In total, 87 eyes of 70 patients aged 58 to 91 years were treated with the XEN-45 Gel Stent. 54 eyes (62%) had a prior glaucoma procedure to lower intraocular pressure (IOP), including laser peripheral iridotomy (LPI). 33 eyes (38%) did not have a prior glaucoma procedure.

Across all 87 eyes, the average IOP decrease at 12 months was 6.50 mmHg (28%), from 18.66 mmHg to 12.16 mmHg, with an average decrease of 2.37 (69%) glaucoma medications, from 3.36 to 0.99 anti-glaucoma medications. Patients with a prior glaucoma procedure had an average IOP decrease of 7.84 mmHg (33%) at 12 months with an average decrease of 2.39 (66%) glaucoma medications. In patients without a prior glaucoma procedure, at 12 months, the average IOP decrease was 4.29 mmHg (20%) on an average of 2.33 (74%) fewer medications. An average of 62.76 micrograms of mitomycin C was used during XEN surgery, ranging from 30 to 80 micrograms.

Across all eyes, the mean IOP at 12-month follow-up was significantly reduced compared to preoperative IOP (P<0.0001). The number of glaucoma medications was also significantly decreased from baseline (P<0.0001) at 12 months. The average IOP decrease in patients without concurrent cataract surgery was significantly greater than in patients with combined XEN and cataract surgery (8 vs. 4 mmHg; P<0.01).

Among all study eyes, there were 28 total complications at or after 1 week post-surgery. The most common types of complication were IOP spike > 12 mmHg (55%), followed by blockage of XEN tip in anterior capsule (21%) and blockage of XEN implant (7%). Patients with at least one previous glaucoma procedure were 4.51 times more likely (OR = 4.51, p= 0.0336) to experience a complication after XEN Gel Stent implantation, compared with patients with no previous glaucoma procedures.

The cumulative proportion of failure was 0.35 for patients with a previous glaucoma procedure and 0.21 for patients without any prior glaucoma procedures, totaling 0.3 for all eyes. Eight patients (9%) required needling after XEN implantation. The cumulative proportion of re-operation was 0.22.

Conclusions:

In this study, the XEN-45 Gel Stent was safe and effective in treating 70% to 80% of patients with refractory glaucoma. The use of the PoST technique provided significant IOP and anti-glaucoma medication reduction compared to pre-operative levels. Additionally, the post-operative needling rate is significantly lower than those previously published. The PoST technique should be considered when using the XEN-45 gel stent in glaucoma patients who have failed previous surgical treatment or are taking multiple glaucoma medications without adequate IOP control.

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