Impact of failed ab-interno trabeculectomy (trabectome) on subsequent XEN45 gel stent implantation in pseudophakic eyes

D Kiessling,T S Dietlein,C Rennings,M Hild,A Lappas,Randolf Alexander Widder,G F Roessler

doi:10.1007/s10792-021-01977-w

D Kiessling, T S Dietlein + Show 5 more

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https://doi.org/10.1007/s10792-021-01977-w

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Abstract

PurposeTo determine the impact of failed ab-interno trabeculectomy on the postoperative outcome of subsequent XEN45 gel stent (Allergan, CA, USA) implantation in pseudophakic eyes.MethodsIn this retrospective single-center study, we included 60 pseudophakic eyes from 60 participants who underwent XEN45 gel stent implantation. Thirty eyes each underwent primary stent implantation (control group) or had previously undergone a failed ab-interno trabeculectomy (trabectome group). The groups were matched at a 1:1 ratio based on the following criteria: preoperative and maximum Intraocular pressure (IOP), preoperative medication score, cup/disk-ratio, follow-up time, best-corrected visual acuity at baseline, age, and the proportion of patients classified as primary open angle glaucoma or exfoliation glaucoma. We defined a successful surgery by the following three scores: an IOP reduction > 20% and IOP at the longest follow-up < 21 mmHg (Score A) or < 18 mmHg (Score B) or IOP ≤ 15 mmHg and an IOP reduction ≥ 40% (Score C). One open conjunctival revision was allowed in all scores, and a repeat surgery was considered a failure.ResultsFollowing an average follow-up period of 22 ± 12 months, we observed a mean IOP reduction of 38%, from 23.5 ± 5.2–14.5 ± 5.0 mmHg. Comparative analyses between the groups did not reveal a significant difference in the postoperative IOP, postoperative medication score, side effects, revision rate, repeat surgery rate, or success rate.ConclusionsTrabectome is a viable first-line procedure for medically uncontrolled glaucoma before filtering ab-interno microstent surgery is considered.

Highlights

In addition to established procedures that are used to treat uncontrolled glaucoma, Microinvasive glaucoma surgery (MIGS), which targets the iridocorneal angle, has been used in routine clinical practice in recent years. trabectome surgery (Microsurgical Technology, Redmond, WA, USA), being just one of them, pursues an ab-interno approach
Comparative analyses between the groups did not reveal a significant difference in the postoperative Intraocular pressure (IOP), postoperative medication score, side effects, revision rate, repeat surgery rate, or success rate
We identified a total of 751 eyes of 581 patients, with 81 (11%) patients undergoing secondary XEN45 gel stent implantation after a failed ab-interno trabeculectomy

Summary

Introduction

In addition to established procedures that are used to treat uncontrolled glaucoma, Microinvasive glaucoma surgery (MIGS), which targets the iridocorneal angle, has been used in routine clinical practice in recent years. trabectome surgery (Microsurgical Technology, Redmond, WA, USA), being just one of them, pursues an ab-interno approach. Trabectome surgery (Microsurgical Technology, Redmond, WA, USA), being just one of them, pursues an ab-interno approach It does not require the penetration of the conjunctiva. Jea et al [9] postulated that Trabectome surgery is a reasonable choice of primary surgery to treat glaucoma and should be considered before traditional filtering surgery. XEN45 gel stent implantation (Allergan, Dublin, CA, USA) is conducted ab-interno via the anterior chamber through the trabecular meshwork and the scleral wall. It targets the formation of a subconjunctival bleb. Several researchers have reported on their favorable safety profile, along with the promising IOP-lowering potential [10,11,12,13,14,15,16]

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