Long-term results of Xen gel stent show IOP reduction potential
WASHINGTON — Implantation of the Xen gel stent can effectively control IOP in patients with glaucoma in the long term, but the stent also demonstrates potentially high rates of reoperation and bleb-related infections, a speaker said here.
At the American Glaucoma Society annual meeting, Hari Jayaram, MA (Hons), MSc, MBMCh, PhD, FRCSEd, shared the 4-year results of a retrospective case note review of all Xen transscleral gel stent (Allergan) procedures performed between 2012 and 2018 at Moorfields Eye Hospital in the United Kingdom.
“When the stent is successful and further revision surgery isn’t required, the stents can lower pressure and reduce the mean medications,” he said.
The study included 426 eyes of 375 patients, with 60% undergoing Xen implantation alone and 40% undergoing Xen implantation with cataract surgery.
Surgical success was defined as a greater than 20% reduction of IOP with or without drops, no reoperation for glaucoma, no endophthalmitis and no loss of perception of light vision. At 1 year, the surgery success rate for all patients was 64%. The surgery success rate decreased to 41% at 4 years, Jayaram said.
In successful surgeries, patients achieved a mean IOP of 15 mm Hg at 4 years, reduced from a baseline IOP of 22.4 mm Hg. Mean medications were reduced to 1.3, down from 2.3 medications at baseline, and 40% of patients were drop-free beyond 2 years, he said.
However, 19% of patients experienced IOP of less than 6 mm Hg in early postoperative phases, and 26% of patients required bleb needling less than 3 months after surgery. Bleb-related infections were reported in 1.6% of patients, he said.
Additionally, 29% required reoperation to manage their glaucoma, with a median time to reoperation of 4 months, he said.
“Surgeons should be aware of the potentially high rates of reoperation and the long-term risk of bleb-related infection,” he said. – by Robert Linnehan
Jayaram H. Long-term experience of Xen trans-scleral gelatin stent in a large specialist glaucoma center. Presented at: American Glaucoma Society annual meeting; Feb. 27-March 1, 2020; Washington.
Disclosure: Jayaram reports he is a consultant and lecturer/speaker for Allergan and is a lecturer/speaker for Santen and Laboratoires Théa.