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

Abstract

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. 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. 186 XEN implant procedures were included in this study from a total of 143 patients. Intraocular pressure changes with time were as follows: preoperative 18.1mmHg (± 5.77), 6months 13.2mmHg (SD ± 3.9), 12months 13.7mmHg (SD ± 5.6) and 24months 12.6mmHg (SD ± 3.1). For visits up to 12months, comparison from preoperative IOP was significant at the < 0.0001 level; for 18 and 24months, significance was < 0.05. Medication usage with time was as follows: preoperative 2.5 (SD ± 1.1) 6months 0.7 (SD ± 0.9), 12months 0.8 (SD ± 0.97), and 24months 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. 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.