Comparative Evaluation Of Minimally Invasive Procedures Using The Xen Gel Stent And Fistula Procedures In Patients With Glaucoma

The development of minimally invasive glaucoma surgery offers the hope of effectively lowering intraocular pressure (IOP) with fewer complications compared to the gold standard of trabeculectomy. This paper is based on a thesis that a minimally invasive glaucoma surgery using the XEN Gel Stent compared to trabeculectomy is an equally effective method of lowering IOP while improving safety.

The aim of this study was comparative evaluation of the efficacy and safety of minimally invasive procedures using the XEN Gel Stent and standard trabeculectomy in patients with open-angle glaucoma. 

Department of Ophthalmology, Silesian University of Medicina in Katowice, Poland

Department of Ophthalmology, Prof K. Gibinski University Clinical Center, Silesian University of Medicine, Katowice, Poland

The retrospective, non-randomised study involved analysis of test results of patients hospitalised at the Department of Ophthalmology of Prof. K. Gibiński University Clinical Centre in Katowice. The analysis involved 91 patients with open-angle glaucoma who had undergone either the XEN Gel Stent implantation procedure (45 patients - group I) or trabeculectomy (46 patients - group II). The analysis covered the period of 36 months. All patients were assessed in terms of IOP, number of anti-glaucoma medications taken, visual field, visual acuity and intra- and postoperative complications

In both groups, a statistically significant reduction in IOP and number of IOP-lowering medications were obtained. The mean reduction in IOP at 36 months was 32.8% for group I and 43.6% for group II. Visual field  remained stable over a two-year period for both groups. Hypotonic complications were significantly more common in group II. Complete success, i.e. IOP reduction of at least 20% without anti-glaucoma medication, was achieved at 36 months of observation by 18.8% - group I and 26.7% - group II. Overall success - IOP reduction of at least 20% without or with medication, was achieved in gropu I and II respectively - 62.6% and 86.7%. Therapeutic failure affected 17.8% of patients from group I and 13% of patients from group II. 

The minimally invasive glaucoma surgery with the XEN Gel Stent compared to trabeculectomy presents lower hypotensive potential, a better safety profile and the vast majority of complications are mild and self-limiting.

Visual field results analysis as an indicator of the long-term efficacy of the procedure, showed that both procedures effectively slow down the progression of glaucomatous neuropathy in the long-term assessment.

XEN Gel Stent implantation is a modern procedure that creates new opportunities, but also challenges in post-operative care. The study shows that the XEN Gel Stent plays an important clinical role in the treatment of patients with open-angle glaucoma with early and moderate glaucomatous loss.