Ab externo placement of gel stent lowers IOP
Placing the Xen45 gel stent using an ab externo technique helped lower IOP in patients with glaucoma, according to a study.
For more than 10 years, the Xen45 gel stent (Allergan) has been approved for ab interno implantation. However, in her presentation at the virtual Association for Research in Vision and Ophthalmology meeting, Natasha N. Kolomeyer, MD, said a new technique has emerged in recent years.
“In the last 2 years, a novel ab externo approach has been adopted by many surgeons to implant the gel stent, therefore going outside-in instead of inside-out,” she said.
Researchers evaluated real-world data from the EXPAND study to determine the effectiveness and safety of the gel stent over 12 months. The study included consecutive patients with elevated IOP requiring surgical intervention.
Patients underwent ab externo placement of the gel stent alone or in combination with phacoemulsification, with or without opening of the conjunctiva, at least 12 months before study inclusion.
The real-world data comprised 472 eyes of 412 patients (54.7% female, mean age 75.1 years). In all, 382 eyes received the gel stent alone, and 12-month data were available for 193 eyes.
Mean IOP decreased by approximately 6 mm Hg from a medicated baseline of 20.8 mm Hg to 14.9 mm Hg at 12 months. In addition, 110 eyes (57%) required topical IOP-lowering medications at 12 months compared with 181 (93.8%) at baseline.
In a safety analysis, the most common adverse events were transient, self-resolving hypotony (22.8%), uncontrolled IOP requiring secondary surgical intervention (13.5%), bleb leak (12.8%), implant exposure/extrusion/conjunctival erosion (6.9%) and choroidal effusion/hemorrhage/mixed effusion hemorrhage (5.9%).
“Overall, the EXPAND study shows that the ab externo technique is a safe and effective alternative to the conventional ab interno technique for Xen gel stent implantation,” Kolomeyer said.
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Kolomeyer NN, et al. Retrospective, multicenter, 12-month evaluation of ab-externo XEN gel stent placement: real-world data from the EXPAND study group. Presented at: Association for Research in Vision and Ophthalmology annual meeting; May 1-7, 2021 (virtual meeting).
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