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 - 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 -