Standalone XEN45 Gel Stent implantation in the treatment of open-angle glaucoma: A systematic review and meta-analysis

Sheng Yang Lim, Bjorn Kaijun Betzler, Leonard Wei Leon Yip, Syril Dorairaj, Bryan Chin Hou Ang

Research output: Contribution to journalReview articlepeer-review

Abstract

The XEN45 Gel Stent (Allergan Inc., Irvine, CA) allows the drainage of aqueous into the sub-conjunctival space, through a minimally-invasive approach. This systematic review and meta-analysis evaluate's its intraocular pressure (IOP)-lowering efficacy and complications in the treatment of open-angle glaucoma. Fourteen studies comprising 963 eyes were included. IOP decreased significantly (P < 0.001) across all timepoints (1 day, 1 week, 1, 3, 6, 12, 18, and 24 months) with a mean decrease of 7.44 mm Hg (95%CI:4.91–9.97) at 24 months. IOP-lowering medications decreased significantly (P < 0.001) across all timepoints (1 week, 1, 3, 6, 12, 18, 24 months) with a mean reduction of 1.67 medications (95%CI:1.28–2.06) at 24 months. Numerical hypotony occurred in 39% (95%CI:14%–67%) and stent exposure in 1% (95%CI:0%–2%) of eyes. 38% (95%CI:30%–46%) of eyes required at least one postoperative needling, with an average of 0.6 (95%CI:0.37–0.81) needlings per eye. Standalone XEN45 Gel Stent implantation is effective in lowering IOP in open-angle glaucoma. Transient numerical hypotony is the most common postoperative complication. Sight-threatening complications are rare. Postoperative needling may be required to maintain IOP-lowering outcomes; however, the overall quality of current evidence is low, with the need for more randomized controlled trials and outcomes measured with a clinically meaningful definition of success.

Original languageEnglish (US)
JournalSurvey of ophthalmology
DOIs
StateAccepted/In press - 2022

Keywords

  • Meta-analysis
  • Minimally invasive glaucoma surgery
  • Open angle glaucoma
  • Systematic review
  • XEN45

ASJC Scopus subject areas

  • Ophthalmology

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