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To investigate the efficacy and safety profile of a novel implantation technique of Xen gelatin stent in patients with conjunctival scarring due to previous failed glaucoma surgery.
Retrospective cohort study of 52 consecutive patients with previous failed glaucoma surgery who underwent an ab-externo implantation of Xen stent. A 3-4 mm conjunctival peritomy was followed by tenectomy and pre-insertion of a 10-0 nylon encircling suture to prevent peri-tubular leakage. The Xen stent was inserted starting 2mm posterior to the limbus. Study visits included pre-op, at 1 day, 1 week, 1, 3, 6, and 12 months post-op. Complete success was deﬁned as IOP ≤18mmHg or decrease in IOP ≥20% with no medications, qualified success as IOP ≤18mmHg or decrease in IOP ≥20% with or without glaucoma medications, and failure as need for additional glaucoma surgery or IOP ≥18mmHg and ≤20% drop.
IOP was reduced from 23.7±6.6mmHg at baseline to 13.9±3.4mmHg at month 6 (p<0.001, N=22), for a mean reduction of 36.3% (95% CI: 27.7, 44.8). Medication use was reduced from 3.2±1.0 to 0.9±1.3 (p<0.001). At 6 months, 57% achieved complete success, 95% qualified success, and 5% failed. 12% required bleb needling and transient, self-limited hypotony (<1 month) was seen in 12%. This technique significantly reduced IOP and medication use at 6 months in patients with previous glaucoma surgery.
The novel ab-externo Xen implantation technique offered significant IOP and medication reduction in patients with previous failed glaucoma surgery who were poor candidates for conventional ab-interno implantation due to conjunctival scarring, while maintaining a good safety profile relative to traditional tube shunt and trabeculectomy surgery.