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Jonathan S Myers, Cindy X Zheng, Stephen J Moster, Michael Lin; Short term outcomes of transconjunctival ab externo XEN 45 Gel Stent implantation. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3735.
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© ARVO (1962-2015); The Authors (2016-present)
The XEN 45 Gel Stent (Allergan, Dublin, Ireland) is typically implanted from an ab interno approach into the superior or superonasal subconjunctival or sub-Tenon’s space to lower intraocular pressure (IOP), but some patients have previous surgery or facial anatomy that prevents implantation in this area. This retrospective clinical chart review evaluated the outcomes of an ab externo superotemporal transconjunctival XEN implantation technique.
Retrospective chart review of patients who underwent ab externo superotemporal transconjunctival XEN implantation.
Ten eyes of 8 patients underwent ab externo XEN implantation. Average patient age was 76.2±6.5 years, 50.0% were female, and 87.5% were Caucasian. Most (7/10) of eyes had primary open angle glaucoma, 2 had pseudoexfoliative glaucoma, and 1 had normal tension glaucoma. Four eyes had severe glaucoma, 4 had moderate, and 2 had mild. Four eyes had undergone previous superonasal XEN an average of 72.3±53.6 days prior to ab externo XEN; planned needling of these flat, superonasal XEN blebs was unsuccessful, leading to an intraoperative decision to perform superotemporal ab externo XEN. Ab externo XEN was chosen in 3 eyes due to superonasal conjunctival scarring from previous trabeculectomies. Pre-operative logMAR VA was 0.16±0.17 (Snellen equivalent 20/29), and IOP was 16.2±5.2 mmHg on 2.2±1.5 glaucoma medications. At most recent follow-up an average of 31.7±23.8 days after surgery, logMAR VA was 0.13±0.14 (Snellen equivalent 20/27, p=0.65), and IOP was 9.7±4.6 mmHg (p=0.009) on 0.3±0.7 glaucoma medications (p=0.002).. One patient was found to have serous choroidal effusions on post-operative day 6, but these improved with addition of atropine and did not require surgical intervention; her vision was 20/25 or better at all subsequent visits through 2 months of follow-up. There were no cases of wound leak or anterior chamber shallowing. IOP≤5 mmHg occurred in 4/10 eyes on post-operative day 1, 2 at week 1, 1 at month 1, and 2 at most recent follow-up.
Ab externo superotemporal transconjunctival XEN implantation demonstrates similar safety and efficacy in the first month to that of ab interno approaches.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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