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. 2020 Sep-Dec;14(3):87-92.
doi: 10.5005/jp-journals-10078-1287.

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

Robert Sharpe  1 , Gina Pham  1 , Peter Chang  1
Affiliations

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

Robert Sharpe et al. J Curr Glaucoma Pract. 2020 Sep-Dec.

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.

How to cite this article: Sharpe R, Pham G, Chang P. Comparison of A b I nterno XEN Gelatin Stent vs Trabeculectomy with Mitomycin C: A Retrospective Study. J Curr Glaucoma Pract 2020;14(3):87-92.

Keywords: Gelatin stent; Glaucoma surgery; Intraocular pressure; Trabeculectomy; XEN.

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Conflict of interest statement

Source of support: Nil Conflict of interest: None

Figures

Fig. 1
Fig. 1
Mean IOP curve preoperatively to 6 months postoperatively for XEN and trab groups
Fig. 2
Fig. 2
Mean IOP curve preoperatively to 6 months postoperatively following XEN based on mitomycin C dose
See this image and copyright information in PMC

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References

    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. DOI: - DOI - PubMed
    1. 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. DOI: - DOI - PubMed
    1. 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. DOI: - DOI - PubMed
    1. 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. DOI: - DOI - PMC - PubMed
    1. 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. DOI: - DOI - PubMed

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