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18 month results of the XEN45 implant used as a solo procedure or combined with cataract surgery in an NHS setting

Poster Details

First Author: F.Allen UK

Co Author(s):    O. Bowes   C. Morley   T. Pearsall   S. Ruben           

Abstract Details

Purpose:

The xen45 gel implant is a minimally invasive filtration procedure used for management of glaucoma. The implant is injected through the trabecular meshwork and has a 45 ┬Ám lumen allowing outflow of aqueous into a subconjunctival or subtenons space created by the injection of mitomycin-c, resulting in a reduction of the intraocular pressure (IOP). We present our 18 month results for xen45 implantation performed as a solo procedure in phakic patients or as a combined procedure with cataract surgery.

Setting:

This work was completed by the glaucoma team in the ophthalmology department at Southend University Hospital NHS Foundation Trust.

Methods:

Outcome data from 91 Xen insertions was collected retrospectively from June 2015 to July 2017. Pre-operative IOP pressure and number of drops taken was compared to post-operative values at 18 month follow up. The number of patients requiring bleb needling was also recorded as was the number of failed xens requiring further surgical intervention. A paired t test was used to compare the pre and postoperative IOP and an unpaired t test to compare the two groups.

Results:

Mean pre-operative IOP in the solo xen group was 22.93mmHg on an average of 2.79 drops. At 18-month follow-up mean IOP was 15.89mmHg on 0.28 drops. This was a statistically significant mean reduction in IOP of 7.04mmHg (p=0.0002). Mean pre-operative IOP in the combined cataract surgery and xen group was 19.16mmHg on 2.93 drops. At 18-month follow-up mean IOP was 14.50mmHg on 0.28 drops. This was a statistically significant mean reduction in IOP of 4.67mmHg (p=0.0001). The solo xen procedure gave a mean of 2.37mmHg additional pressure reduction compared to the combined procedure, this was not statistically significant (p=0.2274).

Conclusions:

The xen implant provides a statistically significant reduction in intraocular pressure in patients when performed solo in phakic patients or combined with cataract surgery. The implant also reduces the burden of drop instillation. It seems that when combined with cataract surgery the xen procedure may provide slightly less pressure reduction however this was not statistically significant and final pressure was similar in the two groups. Xen implant insertion should be considered as an adjunct to cataract surgery in patients in who a drop of IOP or reduced drop instillation is desired.

Financial Disclosure:

None

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