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Outcomes of needle revision after XEN gel implantation: 3 month follow-up study

Poster Details

First Author: T.Snaebjörnsson Arnljóts SWEDEN

Co Author(s):    R. Kasina   M. Economou                 

Abstract Details


The Xen gel implant (Allergan, Dublin, Ireland) is a 6 mm porcine gelatin device that is implanted ab interno into the subconjuctival space under direct gonioscopic visualization. Complications may arise such as subconjunctival fibrosis or encapsulation which obstructs aqueous humour flow, requiring needle revision. This study intends to evaluate frequency, safety and efficacy of needling in patients with medically uncontrolled glaucoma that priorly underwent Xen gel implantation.


The study was conducted at St Erik Eye Hospital at the Karolinska Institute in Stockholm, which is a tertiary referral center for glaucoma surgery serving the whole of Sweden.


Consecutive retrospective chart review of 61 eyes in 57 patients with POAG (Primary Open Angle Glaucoma) or PXG (Pseudoexfoliation Glaucoma) that underwent either implantation of Xen gel alone or in combination with cataract surgery between June 2015 and December 2016 and had a needling procedure afterwards with a minimum follow-up of 1 month. Primary outcome measures were: visual acuity, intraocular pressure and number of glaucoma medications pre- and post-needling, as well as intra- and post-operative complications. All operations were performed by a single experienced surgeon.


A total of 16 of 61 eyes were included that underwent needle revision. Mean pre-needling IOP in this group was 24.0�Â�±7.8 mmHg on 1.4�Â�±1.7 medications. Mean post-needling IOP was reduced to 16.1�Â�±4.9 mmHg (p <0.05) on 1.1�Â�±1.4 medications (p = 0.5). Visual acuity was unaffected. Median follow-up time was 111 (range 31-418) days. No major complications occured but four eyes had minor complications such as peri-operative hyposphagma. Highest needling rate was observed in eyes with PXG that underwent phaco-Xen (50%) while the rate for the whole study group was totally 28%. Data collection and follow-up is ongoing.


This short-term assessment of needling procedure in glaucoma eyes that have undergone Xen gel implantation shows a good IOP-lowering effect (p <0.05), reduction in medication without a change in visual acuity or any major complications. Further studies with longer-term follow up and a larger number of patients are needed to fully assess the safety and efficacy of this procedure.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented

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