June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Comparison of XEN Surgical Outcomes in Safety Net and Insured Patient Populations of Los Angeles County
Author Affiliations & Notes
  • Sourabh Arora
    Ophthalmology, University of Southern California, Los Angeles, California, United States
  • Abinaya Thenappan
    Ophthalmology, University of Southern California, Los Angeles, California, United States
  • Austin Cho
    Ophthalmology, University of Southern California, Los Angeles, California, United States
  • Shaili Davuluru
    Ophthalmology, University of Southern California, Los Angeles, California, United States
  • Joshua Kim
    Saint Louis University, Saint Louis, Missouri, United States
  • Ryan Shean
    Ophthalmology, University of Southern California, Los Angeles, California, United States
  • Eric Yang
    Ophthalmology, University of Southern California, Los Angeles, California, United States
  • Brian Song
    Ophthalmology, University of Southern California, Los Angeles, California, United States
  • Brandon Wong
    Ophthalmology, University of Southern California, Los Angeles, California, United States
  • Van Nguyen
    Ophthalmology, University of Southern California, Los Angeles, California, United States
  • Benjamin Xu
    Ophthalmology, University of Southern California, Los Angeles, California, United States
  • Footnotes
    Commercial Relationships   Sourabh Arora Apellis, Abbvie, Regeneron, Code C (Consultant/Contractor); Abinaya Thenappan None; Austin Cho None; Shaili Davuluru None; Joshua Kim None; Ryan Shean None; Eric Yang None; Brian Song Zeiss Meditech, Code F (Financial Support); Brandon Wong None; Van Nguyen None; Benjamin Xu Abbvie, Code F (Financial Support), Heidelberg Engineering, Ocular Therapeutix, Code F (Financial Support)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 4281. doi:
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      Sourabh Arora, Abinaya Thenappan, Austin Cho, Shaili Davuluru, Joshua Kim, Ryan Shean, Eric Yang, Brian Song, Brandon Wong, Van Nguyen, Benjamin Xu; Comparison of XEN Surgical Outcomes in Safety Net and Insured Patient Populations of Los Angeles County. Invest. Ophthalmol. Vis. Sci. 2023;64(8):4281.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The XEN gel stent, a tube shunt implant, is a surgical device for lowering intraocular pressure (IOP) in eyes with glaucomatous optic neuropathy (GON). In this study, we compare outcomes of ab externo, open conjunctiva XEN implantation among safety net patients of the Los Angeles County Medical Center (LAC) and insured patients of the Roski Eye Institute of the University of Southern California (USC).

Methods : Consecutive patients undergoing XEN implantation augmented with mitomycin C for uncontrolled GON at LAC or USC were recruited for this retrospective comparative case series. Supervising and operating physicians were similar between the two sites. Eligible patients undergoing XEN with or without concurrent phacoemulsification were identified from electronic medical records (EMR) databases. Patient demographic and longitudinal clinical data was gathered for patients who received at least 6 months of post-operative care. Rates of complete success (IOP ≤21 and >5 mmHg with ≥20% reduction from baseline without medications), partial success (IOP ≤21 and >5 mmHg with ≥20% reduction from baseline with medications), and failure (IOP >21 or ≤5 mmHg on two consecutive or <20% reduction from baseline after 3 months; need for additional glaucoma surgical intervention/s; loss of light perception vision) at the 6-month post-operative visit were assessed.

Results : 42 eyes of 40 patients were eligible for analysis. The mean age of included patients was 66.8 ± 13.8 years. 20 of 42 included cases were female (47.6%). The mean pre-op IOP was 22.9 ± 7.9 mmHg on 3.1 ±1.2 medications. The mean 6-month post-op IOP was 14.3 ± 4.2 on 1.7 ± 1.7 medications overall. The mean 6-month IOP was 15.2 ± 3.3 on 1.2 ± 1.3 medications and 13.6 ± 4.7 mmHg on 2.1 ± 1.9 at LAC and USC, respectively. There was no difference in post-op IOP (p=0.13) or number of drops (p=0.22) between sites. The proportions of complete success, partial success, and failure were 20%, 33.3%, and 46.7%, respectively, at LAC and 27.3%, 40.9%, and 31.8%, respectively at USC. The risk of failure was higher at LAC than USC (p=0.03).

Conclusions : XEN surgery produced significant reductions in IOP and drop dependence for patients treated at both LAC and USC. However, the rate of failure was higher in the safety net patient population at LAC. Additional research may identify explanatory factors for this disparity in XEN outcomes.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

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