Does mitomycin-C concentration have any influence on XEN45 gel stent outcomes in a real-world setting?

Three-Year Results of XEN-45 Implantation for Glaucoma Secondary to Fuchs Uveitis Syndrome, Intermediate Uveitis, and Juvenile Idiopathic Arthritis-Related Anterior Uveitis

PURPOSE

To investigate the long-term outcomes of XEN-45 implantation for glaucoma secondary to Fuchs uveitis syndrome (FUS), juvenile idiopathic arthritis (JIA)-related anterior uveitis and intermediate uveitis (IU).

METHODS

This retrospective study evaluated 19 eyes with FUS, 10 eyes with JIA, and nine eyes with IU that underwent XEN-45 Gel Stent implantation. The primary outcome measure was 3-year surgical success, defined as a ≥20% reduction in intraocular pressure (IOP), with a target IOP of 6-21 mmHg. Success was considered complete when IOP control was achieved without glaucoma medication or surgery other than needling and qualified when medication and/or incisional bleb revision were allowed for IOP control. The secondary outcome measures included IOP changes and revision and complication rates.

RESULTS

The 3-year complete success rate was 49% and 67% in the FUS and IU groups, respectively, both significantly higher than the 20% rate in the JIA group (p = 0.01 and 0.02, respectively, log-rank test). The qualified success rate was also significantly higher in the FUS and IU groups than in the JIA group. Significantly more medications were reintroduced in the JIA group within the first year, and the JIA group did not achieve a significantly lower median IOP at the 2- and 3-year visits, contrary to the FUS and IU groups. The bleb revision and secondary glaucoma surgery rates were similar among all groups.

CONCLUSION

XEN-45 demonstrates a favourable safety and efficacy profile for glaucoma secondary to FUS and IU. However, its efficacy is significantly poor for JIA-related uveitic glaucoma.

Results of XEN45 Gel Stent Implantation in the Treatment of Primary Open-Angle Glaucoma Using 5, 10 or 20 μg Mitomycin C: A Pilot Study

Background: No consensus has been reached on the adequate dose of mitomycin C (MMC) in XEN45 gel stent implantation. Lower doses have the potential to reduce MMC-linked side effects. This study aimed to evaluate treatment efficacy of ab interno XEN45 gel stent in primary open-angle glaucoma (POAG) with three different MMC doses. Methods: This retrospective single-centre nonrandomised trail included 54 patients (56 eyes) who underwent XEN45 gel stent implantation for POAG with above-target intraocular pressure (IOP) under medical therapy. Eyes were grouped according to the received MMC dose: Group 1 (20 μg; n = 21), Group 2 (10 μg; n = 14) and Group 3 (5 μg; n = 21). The primary endpoint was the mean IOP change in the three MMC dose groups after 6, 12 and 24 months. Secondary endpoints included the success rate defined as lowering of baseline IOP ≥ 20% and below a cut-off IOP set at three different levels: ≤ 18, ≤ 16 and ≤ 14 mmHg (Criteriums 1, 2 and 3), the mean number of ocular hypotensive medications and the frequency of needling procedures. Results: After 24 months, the overall mean (standard error) IOP was significantly reduced from 24.7 (0.9) mmHg to 15.2 (0.7) mmHg (p < 0.0001). The average IOP change (standard error) in MMC dose groups 1, 2 and 3 was -8.6 (2) mmHg, -10.1 (2.1) mmHg and -10.4 (2.8) mmHg. Complete success (Criterium 1) was achieved in 50%, 62% and 43% of the eyes in groups 1, 2 and 3. No statistically significant difference was found within the first 24 months between the three MMC dose groups for IOP change, success rate, number of ocular hypotensive medications and the frequency of needling procedures. Conclusions: XE45 was effective in all three dose groups. As the success rate did not significantly differ between the MMC doses, these results may support the use of the lowest dose. Trial Registration: ClinicalTrials.gov identifier: 559/2016BO2.

Navigating hypotony challenges with XEN gel implantation

INTRODUCTION

The XEN Gel, a hydrophilic tube meticulously crafted to adhere to the principles of the Hagen - Poiseuille law, is designed to facilitate efficient aqueous shunting without inducing hypotony. Implantable ab interno or ab externo, with or without conjunctival opening, the device shows no significant outcome differences. Despite numerical hypotony signaling failure, patients may fare well below 6 mmHg.

AREAS COVERED

This review provides insights into device variability, challenges related to hypotony, associated risk factors, and hypotony management.

EXPERT OPINION

The progressive evolution of the XEN Gel constitutes a significant advancement in the field of glaucoma management. Comparative studies investigating diverse implantation methodologies, particularly the ab interno and closed conjunctival approaches, highlight the device versatility in addressing individual patient needs. Exploring hypotony from both statistical and clinical perspectives challenges the traditional view of intraocular pressure as a straightforward success or failure indicator. The incidence of hypotony-related issues varies between device models, emphasizes the need for an individualized approach during device selection. Overall, understanding the dynamics of hypotony is crucial for optimizing the outcomes of XEN Gel implantation.