Ab Externo Transconjunctival XEN® 45 Gel Stent Implantation: Efficacy and Safety of a New Surgical Technique

Abstract

Aim: To evaluate the efficacy and safety of XEN® 45 gel stent implantation with a new surgical approach by ab externo transconjunctival technique.

Materials and methods: A total of 31 eyes of 31 patients affected with primary open-angle glaucoma (POAG) were treated with an ab externo transconjunctival approach. All the XEN gel stent implantations were performed at the Department of Ophthalmology of the Hospital of San Severino Marche, AV3- Asur Marche, Macerata, Italy between January 2021 and May 2021, and the follow-up duration was at least 6 months.

Results: A total of 31 eyes of 31 patients (mean age 65.6 ± 12.3 years; 20 males and 11 females) were included in the study. All the patients were affected by POAG. The mean intraocular pressure (IOP) was 25.3 ± 3.8 mm Hg, and the mean number of IOP-lowering topical medications before surgery was 2.7 ± 0.9. No intraoperative complications were reported. During the follow-up, one patient received medical treatment for a choroidal detachment, one patient had a 2 mm hyphema, and one patient had a partial migration of the stent in the anterior chamber. At the 1-month follow-up, the mean IOP was 12.8 ± 2.5 mm Hg and no patient was on IOP-lowering treatment, while at the 3-month and 6-month follow-ups, four patients were on treatment with one IOP-lowering drug. During the follow-up period, seven patients required postsurgical bleb needling, and one patient underwent a revision with PreserFlo® Microshunt implantation. The final mean IOP was 15.9 ± 2.7 mm Hg, and 27 out of 31 patients had an IOP of <18 mm Hg.

Conclusion: Ab externo transconjunctival XEN® 45 gel stent implantation represents a safe and effective surgical treatment approach.

Clinical significance: The ab externo approach represents a safe and effective technique, allowing early surgical timing and widening the group of patients who could benefit from the filtrating surgical technique before many years of topical medical treatment, which causes marked conjunctival alteration.

How to cite this article: Pirani V, Cavallero E, Cesari C, et al. Ab Externo Transconjunctival XEN® 45 Gel Stent Implantation: Efficacy and Safety of a New Surgical Technique. J Curr Glaucoma Pract 2024;18(3):94-97.

Keywords: Ab externo transconjunctival surgical approach; Glaucoma surgery; Microinvasive glaucoma surgery; Primary open-angle glaucoma; XEN® 45 gel stent implantation.

Figs 1A to F

(A) XEN® 45 is precolored by Trypan Blue; (B) Bulbar conjunctiva is carefully lifted in the superotemporal quadrant and a preloaded injector needle is inserted through the conjunctiva at 8 mm from corneal limbus; (C) The preloaded injector needle is pursued between the tenonian capsule below and the mobile conjunctiva above; (D) XEN® 45 in the anterior chamber is regulated throughout the conjunctiva until an optimal length of 1–2 mm; (E) XEN® 45 correctly positioned in the anterior chamber observed by indirect gonioscopy; (F) Subtenonian injection of 0.2 mL solution of MMC 0.1 mg/mL done at 8–10 mm from the limbus

Fig. 2

Number of patients under IOP-lowering therapy before surgical treatment (baseline) and at different follow-up times after ab externo transconjunctival XEN® 45 gel stent implantation

Fig. 3

Number of patients with IOP <18 mm Hg before surgical treatment (baseline) and at different follow-up times after ab externo transconjunctival XEN® 45 gel stent implantation