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Postop events suggest need for ‘attentive’ management after Xen implantation
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A retrospective study of eyes implanted with the Allergan Xen45 gel stent supports evidence that the device can significantly reduce IOP as well as medication burden in patients with glaucoma, although the number of postoperative interventions recorded suggested a need for “attentive postoperative management.”
Researchers at the Medical University of Graz implanted the surgical device in 199 eyes of 160 patients between 2014 and 2016. In 89 eyes followed up at 12 months, mean IOP reduction was 22.7%, from 22.8 mm Hg preoperatively to 17.1 mm Hg (P < .0001). Mean number of IOP lowering medications was 1.8 in 87 eyes at 12 months, down from 2.9 at baseline (P < .0001).
There were no intraoperative complications, although postoperative adverse events were reported, the most common being hypotony on day 1 postoperatively in 16 eyes (8%), followed by hyphema in seven eyes (3.5%). Severe postoperative adverse events included one case of aqueous misdirection and one case of late-onset endophthalmitis.
Forty-four cases (22.1%) required postoperative intervention, either needling to remove tissue adhesions or revision due to stent exposure.
Additional glaucoma surgery was indicated in 28 cases (14.1%) to compensate for insufficient lowering of IOP. Procedures included trabeculectomies in most cases (53.6%), as well as implantation of a second Xen gel stent, transscleral cyclophotocoagulation and trabeculoplasty. Median time to reoperation was 196 days.
“Our results indicate that Xen implantation is a safe and effective surgical intervention leading to a significant IOP and medication reduction with a low rate of complications. However, severe adverse events may occur and needling was indicated in almost every fifth case, demanding an attentive postoperative management,” the authors wrote. – by Patricia Nale, ELS
Disclosures: Heidinger reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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