Comparing Outcomes of Trabeculotomy with Mitomycin C to 45-μm Gelatin Stent Placed Ab Externo with Open Conjunctiva

Ernesto Sabogal; Zoë Ingram; Nino Odishelidze; Hani El Helwe; Henisk K Falah; Jonathan Trzcinski; Nathan Hall; David Solá-Del Valle

doi:10.1016/j.ogla.2023.11.005

Comparing Outcomes of Trabeculotomy with Mitomycin C to 45-μm Gelatin Stent Placed Ab Externo with Open Conjunctiva

Ophthalmol Glaucoma. 2023 Dec 4:S2589-4196(23)00210-7. doi: 10.1016/j.ogla.2023.11.005. Online ahead of print.

Authors

Ernesto Sabogal¹, Zoë Ingram¹, Nino Odishelidze¹, Hani El Helwe¹, Henisk K Falah¹, Jonathan Trzcinski¹, Nathan Hall¹, David Solá-Del Valle²

Affiliations

¹ Department of Ophthalmology, Massachusetts Eye and Ear, Glaucoma Service, Boston, Massachusetts.
² Department of Ophthalmology, Massachusetts Eye and Ear, Glaucoma Service, Boston, Massachusetts. Electronic address: david_sola-delvalle@meei.harvard.edu.

PMID: 38056708
DOI: 10.1016/j.ogla.2023.11.005

Abstract

Purpose: To compare trabeculectomy with mitomycin C (trab-MMC) and XEN45 Gel Stent placed ab externo with open conjunctiva (XGS AEO) with or without cataract surgery in patients with glaucoma.

Design: Nonrandomized, retrospective, comparative study.

Subjects: A total of 204 eyes from 204 glaucoma patients who received XGS AEO or underwent trab-MMC with or without cataract surgery between July 2018 and August 2021 at Massachusetts Eye and Ear.

Methods: Visits from 204 patient charts were reviewed after either trab-MMC or XGS AEO from 2018 to 2021 from a level 3 triage center.

Main outcome measures: Intraocular pressure (IOP), medication burden, Kaplan-Meier success rates, 5-fluorouracil impact, and complications.

Results: One hundred fifty-seven patients underwent trab-MMC and 47 underwent XGS AEO. Groups had similar baseline intraocular pressure (IOP) and medications (meds). Intraocular pressure and meds decreased similarly at 1.5 years (11.2 mmHg vs. 7.4 mmHg, P = 0.62; 2.9 vs. 2.8 meds, P = 0.92, respectively for trab-MMC and XGS AEO). Success was defined as IOP reduction ≥ 20% with 5 mmHg ≤ IOP ≤ 18 mmHg for 2 consecutive visits. Complete success (CS) did not allow meds; qualified success (QS) allowed for ≤ baseline meds. When IOP fluctuations in the first 60 days were not counted as failures, CS was 43% for trab-MMC, about 8.5% higher than for XGS AEO (P < 0.01). Qualified success was similar between the groups (65%-67%). Procedure time was shorter for XGS AEO than trab-MMC (44 vs. 63 minutes, P < 0.01).

Conclusions: XEN45 Gel Stent AEO may provide similar benefits to trab-MMC, especially for patients who tolerate some meds, with shorter procedure times.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Keywords: 5-fluorouracil; Ab externo with open conjunctiva; Gelatin stent; Glaucoma; Microinvasive glaucoma surgery; Surgical outcomes; Trabeculectomy; Trabeculectomy with mitomycin C; XEN Gel Stent.