A retrospective review of XEN implant surgery: efficacy, safety and the effect of combined cataract surgery

Symeon Nicolaou; Tasneem Z Khatib; Zhiheng Lin; Twishaa Sheth; Golden Ogbonna; Lamia Hamidovic; Asad Zaheer; Chrysostomos Dimitriou

doi:10.1007/s10792-021-02069-5

A retrospective review of XEN implant surgery: efficacy, safety and the effect of combined cataract surgery

Int Ophthalmol. 2022 Mar;42(3):881-889. doi: 10.1007/s10792-021-02069-5. Epub 2021 Oct 19.

Authors

Symeon Nicolaou¹, Tasneem Z Khatib², Zhiheng Lin², Twishaa Sheth², Golden Ogbonna², Lamia Hamidovic², Asad Zaheer², Chrysostomos Dimitriou²

Affiliations

¹ Ophthalmology Department, Colchester Eye Centre of Excellence, East Suffolk and North Essex NHS Foundation Trust, Turner Road, Mile End, Colchester, CO4 5JR, ESSEX, UK. s.nicolaou@nhs.net.
² Ophthalmology Department, Colchester Eye Centre of Excellence, East Suffolk and North Essex NHS Foundation Trust, Turner Road, Mile End, Colchester, CO4 5JR, ESSEX, UK.

PMID: 34665372
DOI: 10.1007/s10792-021-02069-5

Abstract

Objectives: To investigate the safety and efficacy of glaucoma XEN stent implantation and examine the effect of undergoing combined phacoemulsification and XEN versus XEN implant alone.

Methods: A retrospective case note review of patients who underwent XEN implantation by a single surgeon over a 24-month period was performed. Outcomes included changes in IOP and medication use after XEN implant insertion as well as complications post-surgery. Subgroup analysis was also performed, separating phaco-XEN (phacoemulsification and XEN implantation) and stand-alone XEN implantation.

Results: 186 XEN implant procedures were included in this study from a total of 143 patients. Intraocular pressure changes with time were as follows: preoperative 18.1 mmHg (± 5.77), 6 months 13.2 mmHg (SD ± 3.9), 12 months 13.7 mmHg (SD ± 5.6) and 24 months 12.6 mmHg (SD ± 3.1). For visits up to 12 months, comparison from preoperative IOP was significant at the < 0.0001 level; for 18 and 24 months, significance was < 0.05. Medication usage with time was as follows: preoperative 2.5 (SD ± 1.1) 6 months 0.7 (SD ± 0.9), 12 months 0.8 (SD ± 0.97), and 24 months 1.7 (SD ± 1.7). All results were significant at < 0.05 level. Subgroup analysis of separate phaco-XEN and stand-alone XEN groups did not reveal significant differences in IOP; however, there was a significant difference between the two groups preoperatively. Initial hypotony occurred in 75 cases (40%). There were 9 cases of hypotonous maculopathy, 3 cases of persistent choroidal effusions, 3 cases of IOP spikes, 1 cases of cyclodialysis cleft and 1 case of corneal decompensation. 25 (13%) cases had needling during their treatment.

Conclusion: The XEN implant appears to be safe and effective at reducing intraocular pressure and medication usage in glaucoma patients. XEN implantation is an effective treatment option for a range of glaucoma types and can be used as a stand-alone procedure or combined with cataract surgery to treat glaucoma patients.

Keywords: Aqueous humour dynamics; Glaucoma; Glaucoma incisional surgery.

MeSH terms

Cataract* / complications
Glaucoma Drainage Implants*
Glaucoma, Open-Angle* / surgery
Humans
Intraocular Pressure
Retrospective Studies
Stents
Treatment Outcome