Abstract
Purpose :
Pseudoexfoliation glaucoma (PXFG) is common in Iceland. This type of glaucoma tends to have higher intraocular pressure (IOP) and overall worse prognosis compared to primary open angle glaucoma (POAG). The purpose of this study was to compare the efficacy, safety and failure rate of an ab interno gelatin microstent implantation (XEN, Aquesys) in patients with POAG as well as patients with PXFG.
Methods :
This was a retrospective study. POAG and PXFG patients had undergone either simultaneous phacoemulsification and XEN surgery or XEN surgery alone. IOP, success rate and number of medications preoperatively (pre-op) and one/two years postoperatively (post-op) was analyzed. Complete success of surgery was defined as IOP reduction of 20% or more from pre-op baseline at one/two years without any glaucoma medications while partial success as IOP reduction of 20% or more (with/without medications).
Results :
IOP from 212 eyes were available at 1year (y) where 102 eyes had POAG and 110 eyes PXFG. Data at 2y were available from 115 eyes where 60 eyes had POAG and 55 eyes PXFG. All groups decreased in IOP from pre-op to 1y and 2y post-op (p<0.0001 for all groups, one-way ANOVA, Tukey’s post hoc). When actual and relative decrease in IOP was compared between all groups (POAG XEN; POAG XEN and phaco; PXFG XEN; PXFG XEN and phaco), no difference was found at 1y (year) and 2y post-op.
Mean number of eye drops in the POAG group dropped from 2.7±0.8 pre-op to 0.7±0.8 at 1y post-op and 1.1±0.8 at 2y post-op. In the PXFG group the drop was from 2.9±0.8 pre-op to 0.8±0.7 at 1y post-op and 0.9±0.9 at 2y post-op (p<0.0001 for all groups, one-way ANOVA, Tukey’s post hoc).
In the POAG group, complete success at 1y post-op was achieved in 25.7% eyes and 16.1% at 2y post-op. Partial success was achieved in 73.3% eyes at 1y post-op and 45.2% at 2y post-op. In the PXFG group, complete success at 1y post-op was achieved in 31.2% eyes and 29.6% at 2y post-op. Partial success was achieved in 76.1% eyes at 1y post-op and 64.8% at 2y post-op.
Conclusions :
The XEN gel implant as a standalone procedure or combined with phacoemulsification demonstrated sufficient IOP reduction after one and two years in all groups as well as there was a decrease in number of eye drops in all groups.
There was no difference in efficacy between patients with POAG versus PXFG at one year but success rate at two years seems to be lower in the POAG group.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.