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Editors Selection IGR 21-1

Surgical Treatment: Managing Drainage Device Complications-2

Comment by Stefano Gandolfi on:

84816 Impact of Combined XEN Gel Stent Implantation on Corneal Endothelial Cell Density: 2-Year Results, Gillmann K; Bravetti GE; Rao HL et al., Journal of Glaucoma, 2019; 0:

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MIGS and MIGS+ are claimed as safer than conventional ab-externo filtering surgeries. When establishing their risk-benefit profile, the long-term impact on corneal endothelium is critical. In fact, an ab-interno non-filtering MIGS was recently withdrawn from the market due to an abnormally increased endothelial cell loss in the mid-term.

Gillman and co-workers tackled this topic in their study, measuring corneal endothelial loss upon a combined phaco and a MIGS+ (i.e., XEN gel), and comparing the data with those obtained in a group undergoing plain phacoemulsification. In their two-year retrospective analysis, they found no significant difference in cell loss between the two study groups. Besides, they offer further some 'food-for-thought' by dissecting selected phenotypes where the loss was somehow higher (i.e., eyes undergoing multiple stent needling).

They offer some 'food-for-thought' by dissecting selected phenotypes where the loss was somehow higher (i.e., eyes undergoing multiple stent needling)

According to the authors themselves, the study must be considered as a 'pilot' study, In fact, the sample size is by far underpowered (according to the expected null-hypothesis, the groups should have included approximately 450 subjects each for an 80% power), the study is retrospective and the authors counted eyes and not patients. However, their effort should be commended, having they dared to step into the difficult and dangerous path of the long-term evaluation of novel surgeries.

The 'no-risk' message, offered by this study, albeit needing further data to be fully extended to everyone, is encouraging.

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