Report Compares Outcomes of 3 Glaucoma Drainage Implants

A study shows the devices ability to lower IOP and their associations with the need for additional interventions.

This article is part of Ophthalmology Advisor’s conference coverage from the 2021 meeting of the American Academy of Ophthalmology, held in New Orleans from November 12 to 15, 2021. The team at Ophthalmology Advisor will be reporting on a variety of the research presented by the ophthalmology experts at the AAO. Check back for more from the AAO 2021 Meeting.


Implants for the treatment of glaucoma all have intraocular pressure (IOP)-lowering capabilities, but in a study that compared 3 devices, 1 reduced IOP significantly more, according to a study presented at the American Academy of Ophthalmology 2021 meeting in New Orleans. The retrospective, observational, real-world research reviewed the implantation of 3 different minimally invasive glaucoma surgery (MIGS) drainage devices in 221 eyes. Investigators reviewed patients implanted with the iStent® Inject (Glaukos) combined with phacoemulsification and endocyclophotocoagulation (ICE2), the bleb forming PreserFlo® MicroShunt (PMS, Santen/Glaukos), and Xen45® (Allergan) implants. 

The UK-based research examined patients who had undergone 1 of these 3 procedures and had at least a year of follow-up. Most patients (162, 73%) received the iStent ICE2 procedure, while 34 (15.4%) underwent the PMS procedure and 25 (11.3%) received Xen45 implants. 

The iStent ICE2 group achieved mean IOP reductions of 4.9±1.9 mm Hg at 6 months and 6.4±2.8 mm Hg at month 12. The Xen45 group achieved IOP reductions of 6.2±2.0 mm Hg at month 6, and 4.7±1.7 at month 12. And the PMS group achieved IOPs of 6.9±4.9 mm Hg and 6.4±2.8 mm Hg at month 12.

Researchers also noted reductions in the mean number of glaucoma medications. Patients in the iStent ICE2 group were able to reduce their number of medications by 0.8±0. The XEN45 group reduced medications by 1.9±0.3. The PMS group reduced medications by 2.2±0.3. were 4.0%, 26.6% and 36%, respectively. 

The XEN45 group required the largest amount of further interventions (36%), and 2 of those (5.8%) required additional glaucoma drainage surgery. The PMS group followed with 26.6% requiring further intervention and 3 eyes (12%) undergoing additional glaucoma drainage surgery. The iStent ICE2 group required the least amount of further interventions at 4.0%. 

“ICE2 provided IOP reduction comparable to that of the bleb-forming Xen45, but PMS provided greater IOP reduction and less medication requirement compared to Xen45 and ICE2,” investigators reported.

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Qidwai U. A real-world comparison of istent inject combined with phacoemulsification and endocyclophotocoagulation (ICE2) with PreserFlo microshunt and Xen45 implants in the UK: A 1-year outcome. Paper presented at: The American Academy of Ophthalmology 2021 Annual Meeting; November 12-15, 2021; New Orleans. Abstract PO226.