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Saami Zakaria, Christopher Ahmed, Nikki Angela Mehran, Sapna Sinha, Reza Razeghinejad, Jonathan S Myers, Marlene R Moster, Daniel Lee, Natasha Kolomeyer; Long-Term Outcomes of Subconjunctival Gel Stent with and without Concomitant Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2020;61(7):947.
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© ARVO (1962-2015); The Authors (2016-present)
We performed a retrospective, observational clinical study to evaluate the one year outcomes of the subconjunctival gel microstent (XEN45, Allergan) in glaucoma patients with and without combined cataract surgery.
Retrospective analysis of patients that received a XEN45 implant for medically uncontrolled glaucoma at a tertiary care center between January 2017-December 2018 was conducted. Demographics, intraocular pressure (IOP), anti-glaucoma medications (AGM), needling, and subsequent glaucoma surgeries were noted. Success was defined as IOP reduction > 20% from baseline and IOP < 18 mm Hg with (qualified success) or without (complete success) glaucoma medication. Subjects receiving additional surgery besides needling/revisions at any point prior to examination intervals were censored, counted as failures, and noted as having subsequent surgeries. Patients with/without combined cataract surgery at the time of stent implantation were also compared.
162 eyes met inclusion criteria (mean age 74, 59% female, 73% white). Mean preop IOP was 24.3 mm Hg (95% CI, 23.0, 25.6). Mean change in IOP was -9.0 (-7.4,-10.7), and -8.4 (-6.8,-9.9), at 6, and 12 months (m, p< .0001 for all). Mean AGM was 3.0 (2.9,3.2) at baseline and 1.2 (1.0, 1.5) at 12m follow up (p<.0001). 44 (27%) eyes required needling. 33 (20%) eyes required subsequent glaucoma surgery within 12m (15% repeat XEN implants, 39% trabeculectomies, 46% tube shunts). 53% and 31% of eyes met criteria for qualified and complete success at 12m. Patients that had combined cataract surgery (N=31) had less IOP reduction (15%) than pseudophakic (N=68) and phakic patients (N=63) (39% and 38%, respectively, p= .001).
This study highlights significant IOP and medication reductions with gel stent implantation. 20% of patients required a subsequent glaucoma surgery, beyond needling or revision, within a 12 month period. Concomitant cataract surgery was associated with less IOP reduction. These findings warrant further study.
This is a 2020 ARVO Annual Meeting abstract.
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