Abstract
Purpose :
The XEN gel stent is touted as comparable to the trabeculectomy, however, many surgeons prefer glaucoma drainage devices (GDD) as a primary glaucoma surgical procedure. To our knowledge there have been no studies comparing XEN to GDD procedures. This study evaluates short-term efficacy and post-op management of the XEN compared to GDD in a real-world private practice setting.
Methods :
We performed a retrospective chart review of 123 patients treated with either glaucoma shunt surgery, using Baerveldt, Molteno, or Ahmed valves, or XEN surgery with ab-interno or ab-externo implantation. The IOP, number of glaucoma medications, visits, and needling interventions were determined for the groups over 3 months. Two-tailed Mann-Whitney U Test was used for statistical analysis.
Results :
A total of 123 patients were included, 35 males, 24 females with a mean age of 75 in the glaucoma shunt group (GSG)(n=59) and 24 males, 40 females with a mean age of 74 in the Xen stent group (XEN)(n=64). GSG used Baerveldt 250mm (n=4), Molteno 3 185mm (n=15), and Ahmed FP7 (n=27) or S2 (n=13) valves. XEN was inserted internally (n=36), and externally (n=27). Pre-op IOP of GSG (26.2±8.95mmHg) was not significantly different from XEN (24.0±7.21mmHg) (p=0.3). XEN had greater percent post-op IOP reduction at 1 month (XEN=37.5%±28.4%, GSG=23.7%±30.8%, p=0.008), however, the reduction was not significantly different at 1 day (XEN=61.7%±37.3%, GSG=45.1%±48.1%, p=0.07), 1 week (XEN=57.9%±23.2%, GSG=44.0%±35.5%, p=0.06), and 3 months (XEN=36.2%±23.5%, GSG=31.9%±26.3%, p=0.3). XEN required more post-op visits over 3 months (XEN=11.9±4.1, GSG =9.53±3.3, p=0.0002). GSG required more IOP-lowering medications at 3 months (3.12±1.08 vs. 2.14±1.46, p=0.0003). Post-op interventions were not significantly different between GSG (1.02±1.23) and XEN (1.34±1.54) (p=0.3).
Conclusions :
Both the GSG and XEN achieved similar percent reduction in IOP at 3 months of 31.9-36.2%. XEN required significantly more post-op visits, while GSG required significantly more post-op medicines to achieve the reduction in IOP. Although there were more post-op visits in the XEN group, this could be due to lack of experience with the relatively new procedure. In a private practice setting, the two procedures produced a similar IOP reduction at the end of the global period with a slight variation in post-op management.
This is a 2021 ARVO Annual Meeting abstract.