TY - JOUR
T1 - Standalone XEN45 Gel Stent implantation in the treatment of open-angle glaucoma
T2 - A systematic review and meta-analysis
AU - Lim, Sheng Yang
AU - Betzler, Bjorn Kaijun
AU - Yip, Leonard Wei Leon
AU - Dorairaj, Syril
AU - Ang, Bryan Chin Hou
N1 - Funding Information:
SYL and BKB report no conflicts of interest, financial or propriety, in the subject matter or materials discussed in this manuscript. LWLY is a consultant for Allergan plc and has received previous funding from Allergan for travel and research. However, he has not received funding for his work in this publication. SD is a consultant for New World Medical, Inc; Iridex Corporation, and Santen Pharmaceutical Co., Ltd and has received previous funding for travel and research. He has not received funding for his work in this publication. BCHA has received previous funding from Allergan plc for travel and research. However, he has not received funding for his work in this publication. The authors alone are responsible for the content and writing of the paper.
Publisher Copyright:
© 2022
PY - 2022/7/1
Y1 - 2022/7/1
N2 - 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 evaluates 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.
AB - 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 evaluates 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.
KW - Meta-analysis
KW - Minimally invasive glaucoma surgery
KW - Open angle glaucoma
KW - Systematic review
KW - XEN45
UR - http://www.scopus.com/inward/record.url?scp=85126317973&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85126317973&partnerID=8YFLogxK
U2 - 10.1016/j.survophthal.2022.01.003
DO - 10.1016/j.survophthal.2022.01.003
M3 - Review article
C2 - 35081414
AN - SCOPUS:85126317973
SN - 0039-6257
VL - 67
SP - 1048
EP - 1061
JO - Survey of Ophthalmology
JF - Survey of Ophthalmology
IS - 4
ER -