Clinical Ophthalmology (Jan 2023)
Intraocular Pressure and Medication Changes Associated with Xen Gel Stent: A Systematic Review of the Literature
Abstract
Joseph F Panarelli,1 Vanessa Vera,2 Arsham Sheybani,3 Nathan Radcliffe,4 Richard Fiscella,2 Brian A Francis,5 Oluwatosin U Smith,6 Robert J Noecker7,8 1Department of Ophthalmology, New York University, New York, NY, USA; 2Allergan, an AbbVie Company, Dublin, Ireland; 3Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA; 4Department of Ophthalmology, New York Eye and Ear Infirmary, New York, NY, USA; 5Department of Ophthalmology, Doheny Eye Institute, University of California Los Angeles, Los Angeles, CA, USA; 6Glaucoma Associates of Texas, Dallas, TX, USA; 7Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA; 8Ophthalmic Consultants of Connecticut, Fairfield, CT, USACorrespondence: Joseph F Panarelli, Department of Ophthalmology, New York University, 222 E 41st St, 3rd Floor, New York, NY, 10017, USA, Email [email protected]: The Xen gel stent (Allergan Inc, an AbbVie company; Dublin, Ireland) was conceived as an option for patients requiring modest IOP reduction but for whom trabeculectomy was not yet indicated. As with any glaucoma surgery, establishing criteria for patient selection and identifying factors that contribute to a high likelihood of success are important. To help guide clinical decision-making, a systematic review of published studies on the gel stent was performed, with the goal of understanding postoperative outcomes based on clinical and patient factors. Results were organized around a series of pertinent clinical questions based on scenarios encountered in clinical practice. Criteria for including studies were intentionally broad, with the objective of simulating the diverse population of glaucoma patients encountered in real-world practice. Outcomes for IOP and medication reduction postoperatively were assessed in various analyses, including in eyes with various glaucoma types and severity; in eyes naïve to surgery as well as those with a history of prior incisional glaucoma surgery; and when surgery was performed as a standalone procedure or at the time of cataract surgery. The results of each of the various analyses were consistent in demonstrating that successful gel stent surgery achieved a postoperative IOP of approximately 14.0 mm Hg and reduction to fewer than 1 glaucoma medication. Additional data are shown on outcomes by method of implant (ab interno vs ab externo); intraoperative use of antifibrotics; and rates of needling in published studies.Keywords: glaucoma, glaucoma surgery, bleb, Xen, gel stent
