Abstract
Purpose :
To compare the safety and efficacy of open conjunctiva (OC) and closed conjunctiva (CC) approaches for ab-externo and ab-interno XEN gel stent implantation at 24 months.
Methods :
A retrospective study of 84 eyes (33 OC and 51 CC) with refractory primary or secondary open angle glaucoma who received a XEN gel stent. The surgical implantations were done either as a stand-alone procedure or combined with cataract surgery and were preformed by 3 different surgeons. Patient demographics, diagnoses, pre and postoperative data, and outcome measures including surgical success, intraocular pressure (IOP), number of glaucoma medications, bleb revision, additional IOP lowering procedures and complications were collected. Complete surgical success was defined as a postoperative IOP ≤ 14 or an IOP between 15-18 mmHg with a reduction in medications. Eyes requiring any additional IOP lowering procedure or eyes with complications were considered a failure. Statistical analysis was preformed with P<0.05 as significant.
Results :
Mean preoperative IOP was 20.4 ± 6.5 mmHg for the OC group and 22.08 ± 8.4 mmHg for the CC group (p=0.45). The mean preoperative number of glaucoma medications was 3.07 ± 1.17 for the OC group and 3.14 ± 1.48 for the CC group (p=0.42). Complete success was achieved by 68.7% in the OC group, and 51.5% in the CC group (p <.001). At 24 months, mean IOP was reduced to 13.33 ± 2.68 mmHg in the OC group and 14.25 ± 4.88 mmHg in the CC group (p=0.08). At 24 months, the number of medications was reduced to 1.33 ± 1.19 for the OC and 2.05 ± 1.66 for the CC group (p=0.02). Average time to needling, if one was done, was 107 days for OC, and 42.93 days for the CC group (p=0.01).
Conclusions :
The data suggests both OC and CC methods present viable options for XEN gel stent implantation, with the OC approach demonstrating particular efficacy in complete success, postoperative medication use and time to first needling while demonstrating a high profile safety.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.