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  • MIGS Surgery: Safety and Efficacy of the XEN45 Gel Stent

    By Lynda Seminara
    Selected By: Deepak P. Edward, MD
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    Journal Highlights

    Graefe’s Archive for Clinical and Experimental Ophthalmology
    Published online Jan. 22, 2018

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    The XEN45 Gel Stent (Allergan) is a flexible hydrophilic tube used for minimally invasive glaucoma surgery (MIGS). The stent is placed in the subconjunctival space, and its flexibility and small diameter pose minimal stress to surrounding tissue, thus decreasing the possibility of erosion or migration. The stent also is designed to avoid hypotony, obviating a valve system. Widder et al. studied the device’s risk profile and ability to lower intraocular pressure (IOP) and observed favorable results for both endpoints.

    In their study, results were analyzed for 233 eyes that received stent place­ment in an effort to achieve IOP reduction without medication. Stent placement was used as a pseudophakic standalone procedure (139 eyes), as a phakic standalone procedure (45 eyes), or in combination with cataract surgery and lens implantation (49 eyes). The primary success rate was based on the number of eyes in which appropriate IOP was attained without medication or surgical revision. The overall success rate allowed for 1 surgical revision. The mean follow-up time was 8.5 months.

    Mean IOP was lowered from 24.3 mm Hg to 16.8 mm Hg, and revision surgery was performed in 80 eyes (34%). After the initial revision, mean IOP was 14.0 mm Hg. The primary success rate was 66%, and the overall success rate was 90%. The primary suc­cess rate was higher for pseudophakic eyes (73%) than for phakic eyes (53%) or eyes with combination surgery (55%). Therefore, it may be prudent to com­bine cataract and angle-related surgery, recognizing that the XEN45 stent could be implanted later, with better outcomes expected in pseudophakic eyes. The most common side effects were intra­operative bleeding (9.4%) and post­operative hyphema (5.6%); the latter resolved spontaneously.

    The original article can be found here.