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

Abstract

PurposeTo compare trabeculectomy with mitomycin C (trab-MMC) and XEN®45 Gel Stent placed ab externo with open conjunctiva (XGS AEO) with or without cataract surgery in patients with glaucoma. DesignNonrandomized, retrospective comparative study. SubjectsA total of 204 eyes from 204 glaucoma patients who received XGS placed AEO or underwent trab-MMC with or without cataract surgery between July 2018 and August 2021 at Massachusetts Eye and Ear. MethodsVisits from 204 patients’ charts were reviewed following either trab-MMC or XGS AEO from 2018-2021 from a level 3 triage center. Main Outcome MeasuresIntraocular pressure (IOP), medication burden, Kaplan-Meier success rates, 5-fluorouracil impact, and complications. Results157 patients underwent trab-MMC and 47 underwent XGS AEO. Groups had similar baseline intraocular pressure (IOP) and medications (meds). IOP 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). QS was similar between the groups (65-67%). Procedure time was shorter for XGS AEO than trab-MMC (44 vs 63 min, p<0.01). ConclusionsXGS AEO may provide similar benefits to trab-MMC, especially for patients who tolerate some meds, with shorter procedure times.