Journal of Current Glaucoma Practice

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VOLUME 14 , ISSUE 3 ( September-December, 2020 ) > List of Articles

Original Article

Comparison of Ab Interno XEN Gelatin Stent vs Trabeculectomy with Mitomycin C: A Retrospective Study

Robert Sharpe, Gina Pham, Peter Chang

Keywords : Gelatin stent, Glaucoma surgery, Intraocular pressure, Trabeculectomy, XEN

Citation Information : Sharpe R, Pham G, Chang P. Comparison of Ab Interno XEN Gelatin Stent vs Trabeculectomy with Mitomycin C: A Retrospective Study. J Curr Glaucoma Pract 2020; 14 (3):87-92.

DOI: 10.5005/jp-journals-10078-1287

License: CC BY-NC 4.0

Published Online: 01-12-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim: To compare outcomes of ab interno XEN gelatin stent (Allergan, Dublin, Ireland) implantation vs trabeculectomy with mitomycin C (MMC). Materials and methods: A retrospective review was conducted of eyes that underwent standalone XEN implantation or trabeculectomy with MMC at a single institution from 2014 to 2019. Intraocular pressure (IOP), visual acuity, glaucoma medications, complications, and postoperative interventions were evaluated. The primary endpoint was the reduction in IOP at 6 months postoperatively. Secondary endpoints included the incidence of postoperative intervention and complications. Results: One hundred and seventy-nine eyes were included who underwent XEN (n = 90) or trabeculectomy (n = 89). The mean age was 74.5 ± 7.6 and 68.1 ± 8.2 years old for the XEN and trab groups, respectively (p < 0.001). Baseline IOP for XEN was 17.8 ± 6.0 vs 20.4 ± 9.0 mm Hg for the trab group (p = 0.03). At 6 months, mean IOP for XEN group was 13.5 ± 5.9 mm Hg, representing a 24.1% IOP reduction from baseline (p < 0.001) while mean for trab group was 10.8 ± 4.8 representing a 47% IOP reduction from baseline (p < 0.001). The mean IOP was 2.7 mm Hg lower in trab compared to the XEN group at 6 months (p < 0.003). The number of medications was reduced in both groups from 2.9 ± 1.1 and 3.1 ± 0.9 to 1.1 ± 2.3 and 0.8 ± 1.4 by 6 months postoperatively for XEN and trab groups, respectively (p < 0.001). Complication rates were low for both groups. The needling rate was 30% in XEN vs 7.9% in the trab group (p < 0.001), and 46.1% of eyes in the trab group underwent laser suture lysis. Additionally, IOP reduction and complication rates were similar following XEN in eyes receiving <40 or ≥40 μg of MMC. Conclusion: XEN implantation produces a substantial reduction in IOP with a favorable safety profile comparable to trabeculectomy. Careful postoperative bleb management is critical to obtain optimum outcomes, and higher MMC doses appear safe and may reduce needling rates. Clinical significance: This study confirms the safety and efficacy of XEN gelatin stent implantation in comparison to trabeculectomy with MMC.


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  1. Tham YC, Li X, Wong TY, et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology 2014;121(11):2081–2090. DOI: 10.1016/j.ophtha.2014.05.013.
  2. Heijl A, Leske MC, Bengtsson B, et al. Reduction of intraocular pressure and glaucoma progression: results from the early manifest glaucoma trial. Arch Ophthalmol 2002;120(10):1268–1279. DOI: 10.1001/archopht.120.10.1268.
  3. Gedde SJ, Feuer WJ, Shi W, et al. Treatment outcomes in the primary tube versus trabeculectomy study after 1 year of follow-up. Ophthalmology 2018;125(5):650–663. DOI: 10.1016/j.ophtha.2018.02.003.
  4. Gedde SJ, Herndon LW, Brandt JD, et al. Postoperative complications in the tube versus trabeculectomy (TVT) study during five years of follow-up. Am J Ophthalmol 2012;153(5):804–814.e1. DOI: 10.1016/j.ajo.2011.10.024.
  5. Lewis RA. Ab interno approach to the subconjunctival space using a collagen glaucoma stent. J Cataract Refract Surg 2014;40(8):1301–1306. DOI: 10.1016/j.jcrs.2014.01.032.
  6. Grover DS, Flynn WJ, Bashford KP, et al. Performance and safety of a new ab interno gelatin stent in refractory glaucoma at 12 months. Am J Ophthalmol 2017;183:25–36. DOI: 10.1016/j.ajo.2017.07.023.
  7. Schlenker MB, Gulamhusein H, Conrad-Hengerer I, et al. Efficacy, safety, and risk factors for failure of standalone ab interno gelatin microstent implantation versus standalone trabeculectomy. Ophthalmology 2017;124(11):1579–1588. DOI: 10.1016/j.ophtha.2017.05.004.
  8. Heidinger A, Schwab C, Lindner E, et al. A retrospective study of 199 Xen45 stent Implantations from 2014 to 2016. J Glaucoma 2019;28(1):75–79. DOI: 10.1097/IJG.0000000000001122.
  9. Karimi A, Lindfield D, Turnbull A, et al. A multi-centre interventional case series of 259 ab-interno XEN gel implants for glaucoma, with and without combined cataract surgery. Eye (Lond) 2019;33(3):469–477. DOI: 10.1038/s41433-018-0243-8.
  10. Marcos Parra MT, Salinas Lopez JA, Lopez Grau NS, et al. XEN implant device versus trabeculectomy, either alone or in combination with phacoemulsification, in open-angle glaucoma patients. Graefes Arch Clin Exp Ophthalmol 2019;257(8):1741–1750. DOI: 10.1007/s00417-019-04341-y.
  11. Lenzhofer M, Kersten-Gomez I, Sheybani A, et al. Four-year results of a minimally invasive transscleral glaucoma gel stent implantation in a prospective multi-centre study. Clin Exp Ophthalmol 2019;47(5):581–587. DOI: 10.1111/ceo.13463.
  12. Reitsamer H, Sng C, Vera V, et al. Two-year results of a multicenter study of the ab interno gelatin implant in medically uncontrolled primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 2019;257(5):983–996. DOI: 10.1007/s00417-019-04251-z.
  13. Smith M, Charles R, Abdel-Hay A, et al. 1-Year outcomes of the Xen45 glaucoma implant. Eye (Lond) 2019;33(5):761–766. DOI: 10.1038/s41433-018-0310-1.
  14. Mietz H, Krieglstein GK. Three-year follow-up of trabeculectomies performed with different concentrations of mitomycin-C. Ophthalmic Surg Lasers 1998;29(8):628–634.
  15. Sanders SP, Cantor LB, Dobler AA, et al. Mitomycin C in higher risk trabeculectomy: a prospective comparison of 0.2- to 0.4-mg/cc doses. J Glaucoma 1999;8(3):193–198. DOI: 10.1097/00061198-199906000-00008.
  16. Kupin TH, Juzych MS, Shin DH, et al. Adjunctive mitomycin C in primary trabeculectomy in phakic eyes. Am J Ophthalmol 1995;119(1):30–39. DOI: 10.1016/S0002-9394(14)73810-3.
  17. Gillmann K, Bravetti GE, Mermoud A, et al. XEN gel stent in pseudoexfoliative glaucoma: two-year results of a prospective evaluation. J Glaucoma 2019;28(8):676–684. DOI: 10.1097/IJG.0000000000001295.
  18. Tan SZ, Walkden A, Au L. One-year result of XEN45 implant for glaucoma: efficacy, safety, and postoperative management. Eye (Lond) 2018;32(2):324–332. DOI: 10.1038/eye.2017.162.
  19. Kitazawa Y, Suemori-Matsushita H, Yamamoto T, et al. Low-dose and high-dose mitomycin trabeculectomy as an initial surgery in primary open-angle glaucoma. Ophthalmology 1993;100(11):1624–1628. DOI: 10.1016/S0161-6420(93)31426-0.
  20. Sheybani A, Dick HB, Ahmed II. Early clinical results of a novel ab interno gel stent for the surgical treatment of open-angle glaucoma. J Glaucoma 2016;25(7):e691–e696. DOI: 10.1097/IJG.0000000000000352.
  21. Galal A, Bilgic A, Eltanamly R, et al. XEN glaucoma implant with mitomycin C 1-year follow-up: result and complications. J Ophthalmol 2017;2017:5457246. DOI: 10.1155/2017/5457246.
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