Abstract
BackgroundTo compare the efficacy of phacoemulsification (PKE) combined with nonpenetrating deep sclerectomy (NPDS) with mitomycin C (MMC) versus XEN® gel stent with MMC.MethodsIn this nonrandomized, retrospective, comparative, single-center pilot study, 105 consecutive eyes of 75 patients with uncontrolled primary open-angle glaucoma (POAG) and cataract who underwent PKE combined with either XEN implantation (n = 47) or NPDS (n = 58) between May 2013 and November 2018 were included. The primary outcome was complete success at 9 months, which was defined as intraocular pressure (IOP) ≤18, 15 or 12 mmHg without treatment; qualified success was IOP ≤18, 15 or 12 mmHg with antiglaucoma medications. Secondary outcome measures included the number of antiglaucoma medications, visual acuity (VA), and postoperative adverse events.ResultsUsing the 18 mmHg threshold, complete or qualified success was achieved in 69.6 and 89.1% in the PKE + XEN group, and 63.8 and 89.7% in the PKE + NPDS group (p = .54 and p = .93), respectively, at 9 months. The mean IOP decreased from 20.8 ± 6.8 mmHg to 16.2 ± 2.8 mmHg in the PKE + XEN group (p < .001, 18.9% mean drop), and from 21.5 ± 8.9 mmHg to 14.9 ± 3.9 mmHg in the PKE + NPDS group (p < .001, 25.6% mean drop). Best-corrected VA significantly improved (p < .001) in both groups. The mean number of antiglaucoma medications was significantly reduced from 2.66 ± 1.1 to 0.49 ± 1.0 in the PKE + XEN group (p < .001) and from 2.93 ± 0.9 to 0.69 ± 1.2 in the PKE + NPDS group (p < .001).ConclusionsThe XEN stent combined with PKE seemed to be as effective and safe as PKE + NPDS at 9 months in this pilot study.
Highlights
To compare the efficacy of phacoemulsification (PKE) combined with nonpenetrating deep sclerectomy (NPDS) with mitomycin C (MMC) versus XEN® gel stent with Mitomycin C (MMC)
The purpose of this study was to compare the efficacy and safety of PKE combined with NPDS (PKE + NPDS) and mitomycin C (MMC) versus PKE combined with the XEN® gel stent (PKE + XEN) and MMC in OAG
Forty seven eyes of 36 patients and 58 eyes of 39 patients were respectively included in the PKE + XEN® group and in the PKE + NPDS group
Summary
To compare the efficacy of phacoemulsification (PKE) combined with nonpenetrating deep sclerectomy (NPDS) with mitomycin C (MMC) versus XEN® gel stent with MMC. Trabeculectomy remains the gold standard glaucoma surgery, nonpenetrating deep. The development of microinvasive glaucoma surgery (MIGS) with an optimal safety profile promotes combined cataract and glaucoma surgery [8]. Among these techniques, XEN® Gel Stent (Allergan Inc., Irvine, CA, USA), a glutaraldehyde cross-linked porcine collagen tube 6 mm in length and 45 μm in diameter is the only MIGS with ab interno implantation [9] that uses the subconjunctival drainage pathway [10]. To the best of our knowledge, no studies have compared PKE + XEN and PKE + NPDS
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