The following is a summary of “Ab-Externo XEN Gel stent implantation effectively treated refractory glaucoma with prior failed shunt tube,” published in the August 2024 issue of Ophthalmology by Cheng et al.
Researchers conducted a retrospective study to evaluate the effectiveness of a gelatin stent (XEN 45 Gel Stent; Allergan) implant in eyes with advanced glaucoma that had failed aqueous shunt implantation.
They reviewed 6 patients with refractory glaucoma, characterized by persistently high intraocular pressure (IOP) (>21 mmHg) despite using 3 IOP-lowering medications after undergoing glaucoma drainage device (GDD) implantation, with or without a second GDD or cilioablative procedure. Mitomycin C was administered to patients with eyes that had failed GDDs, followed by subconjunctival 0.3 cc (0.4 mg/ml) treatment, tenonectomy, and an Ab externo XEN stent placement. Outcomes were changes in IOP and the number of glaucoma medications. Success is defined as achieving an IOP ≤18 mmHg with either a 25% reduction in IOP or a reduction of 15 mmHg and a 40% mean IOP reduction from baseline while using the same number or fewer medications.
The results revealed that all 6 eyes had open-angle glaucoma, with an average age of 77.6 ± 7.82 years, and underwent XEN implantation in conjunction with GDD surgery. The IOP decreased from 32.33 ± 5.99 mmHg to 12.67 ± 3.27 mmHg (P< 0.001) over a follow-up period of 13.9 ± 2 (11.7–16.7) months. Visual acuity and field remained stable after XEN placement. Compared to a baseline average of 4.2 ± 0.8 medications, all medications were discontinued except for 1 eye, which required 2 drops at the end of the follow-up. The overall surgical success rate was 100%, with no complications, needling, or procedures.
They concluded a successful implantation of the XEN stent with failed GDD. Gel stent implantation, combined with mitomycin C and tenonectomy, can be considered a viable surgical option for patients with a history of failed tube shunts who require IOP reduction.
Source: bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-024-03648-7
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