XEN Gel Stent Bleb Survives Longest With Ab-Externo Approach

During XEN^® Gel Stent (AqueSys, Inc.) implantation, an ab-externo approach resulted in bleb survival of nearly twice as long compared with an ab-interno approach. These findings were presented during the American Society of Cataract and Refractive Surgery (ASCRS) annual meeting held July 23-27, 2021, in Las Vegas, Nevada.

Eyes (N=72) that underwent primary open-angle glaucoma surgery with XEN gel stent implantation were assessed in this study. An ab-interno approach was used for 39 eyes and ab-externo approach for 33 eyes. Surgical success at 6 months, as defined by intraocular pressure ≤15 mm Hg and ≥25% reduction from baseline of intraocular pressure (IOP) or medication without vision-threatening complications, were compared between surgical approaches.

The rate of surgical success was 59.0% for ab-interno and 42.4% for ab-externo approaches (P =.16).

The average IOP was 15.5 mm Hg and 16.0 mm Hg at 6 months for the ab-interno and ab-externo cohorts (P =.678), respectively. Compared with baseline, the average IOP was reduced by 41.0% among the ab-interno patients and 19.4% among the ab-externo approaches (P =.08).

At 6 months, patients in the ab-interno cohort had reduced medication by an average of 2.00 to 1.1 and the ab-externo cohort reduced medication by 1.5 to 1.5 (both P ≥.197).

Needling was required for blebs among 48.7% of ab-interno and 39.4% of ab-externo procedures (P =.428). The mean time to needling was shorter for the ab-interno approach procedures (28.6 vs 53.6 days; P =.036). Bleb failure was observed among 53.8% and 48.6% for the ab-interno and ab-externo approaches (P =.783), respectively.

The study authors concluded that both ab-interno and ab-externo approaches for XEN gel stent implantation among patients with open-angle glaucoma resulted in similar outcomes with the exception that blebs after an ab-externo approach survived nearly twice as long as blebs after an ab-interno surgical approach.

Disclosure: One study author declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  

Reference

Nguyen V, An J. Xen gel stent implantation in primary open-angle glaucoma patients: comparison of surgical approaches. Presented at: 2021 ASCRS Annual Meeting; July 23-27, 2021; Las Vegas, NV. Poster 78122.