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Six month outcomes of solo XEN and combined phaco-XEN in a district hospital setting in UK

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Session Details

Session Title: Glaucoma

Session Date/Time: Monday 09/10/2017 | 08:00-10:30

Paper Time: 09:06

Venue: Room 4.1

First Author: : J.van der Hoek UK

Co Author(s): :    M. Blizzard                    

Abstract Details


The Xen Gel Stent implantation is a novel minimally invasive technique used in the treatment of primary open angle glaucoma. It is inserted via an ab-interno procedure to create a sub-conjunctival flow of aqueous. Implantation of a Xen Gel Stent is commonly combined with phaco-emulsification for combined treatment of cataract and glaucoma. The limited available literature suggests that there is no difference in the proportion of successful outcomes of phaco- xen compared to solo Xen implantation This work aimed to monitor and assess the outcomes achieved with the adoption of this new procedure and compare combined and solo procedures.


This work was performed by the glaucoma team of the ophthalmology department of Scarborough General Hospital, a regional secondary referral centre in the north of England, United Kingdom serving a mainly rural population of 260.000 people.


Outcome data from 56 Xen insertions was collected retrospectively from April 2016 to March 2017 at Day 1 (D1) , Month 1, 3, 6 and 12 (M1, M3, M6, M12) using a specially adapted computer database. The primary outcomes were IOP & need for topical glaucoma treatment. Patients were assigned to four outcome groups allowing production of Kaplan-Meier survival curves.
 “Success” was >20% IOP reduction without topical pressure lowering treatments. 
“Qualified success” was >20% IOP reduction with ongoing topical treatments
“Maintained” was IOP <22mmHg without topical treatments. 
“Failure” was IOP >22mmHg The number of complications and additional procedures was also collected.


Data was collected on 56 consecutive procedures; Mean age was 74.3 (43-92), 28/56 female, 38 phaco-xen, mean pre-op IOP 23.6 (13-48); 18 solo-xen, mean pre-op IOP 25.2 (17-40); Mean IOP was reduced to 16.9 mmHg in phaco-xen and 15.3 mmHg in solo-xen at M6. 40% achieved ‘success’ and 65% qualified at M6 in phaco-xen. 69% had success and 76% qualified in solo-xen. 63% of solo-Xen and 40% of phaco-xen had IOP<15mmHg at M3. 2 patients had transient hypotony. Further interventions were performed on 10 eyes (17.5%); Topical medications were reduced from mean 2.4 pre-op and 0.2 at M3.


Our early ‘real world’ clinical outcomes show good reductions in IOP and use of medication albeit with lower success rates than shown in published data. Although Xen placement is a convenient operation to combine with cataract surgery our data suggest that combining phaco with Xen produces less effective IOP lowering than Xen alone.

Financial Disclosure:


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