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Editors Selection IGR 22-2

Surgical Treatment: Long-Term Outcomes of XEN Gel Stent

Comment by Kaweh Mansouri on:

95113 Three-year effectiveness and safety of the XEN gel stent as a solo procedure or in combination with phacoemulsification in open-angle glaucoma: a multicentre study, Reitsamer H; Vera V; Ruben S et al., Acta Ophthalmologica, 2022; 100: e233-e245

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Reitsamer et al. present three-year results of the XEN Gel Stent in patients in patients with open-angle glaucoma. This was a retrospective chart review of 212 patients who were included at baseline and in nine European centers. Of note, of these 212 eyes, data from only 85 eyes (40%) were available at three years.

At three years, IOP had decreased from an average of 20.7 mmHg to 13.9 mmHg (33%) and medications from 2.5 to 1.1. The proportions of eyes achieving a > 30% and 40% IOP reduction from baseline were 54.2% and 37.5%, respectively. Of interest, the proportion of eyes that were considered a success was remarkably stable from year one through year three (62% vs 66%). Similar findings were reported by our group after three years.¹It seems that once the first crucial year after XEN implantation is successfully passed, these eyes continue to do well over the next several years, potentially attesting to the importance of adequate post-operative management.

Once the first crucial year after XEN implantation is successfully passed, these eyes continue to do well over the next several years, potentially attesting to the importance of adequate post-operative management

Needling was required in 44% of eyes, most of which was done in the first year. A further 11 eyes (5.1%) required open-conjunctiva bleb revision and another 12.3% needed a secondary surgical intervention. These numbers are similar to previously reported studies. The paper also reported four-year data from 35 eyes (16.5%). However, this sample should be considered to small to enable any meaningful evaluation.

Although a total of 14.6% of eyes reported adverse events, the majority of these were considered mild, with one case of endophthalmitis, one case of persistent hypotony and four cases of clinical hypotony, and four cases of implant extrusion being the most severe.

In conclusion, this studies adds to a growing body of evidence that show XEN gel stent to provide - both as stand-alone and in combination with cataract surgery - an important reduction of IOP and medications after three years post surgery. Its safety profile can be considered superior to classic filtration surgery.

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