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One year efficacy and safety of inferior implantation of Xen 45® Gel Stent in refractory glaucomaEfficacité et sécurité à un an de l implantation inférieure du stent Xen Gel 45® dans le glaucome réfractaire

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Bastelica, P. | Amatu, J. B. | Buffault, J. | Majoulet, A. | Labbé, A. | Baudouin, C.

Edité par CCSD ; Elsevier Masson -

International audience. © 2024 Elsevier Masson SASPurpose: The goal of this study was to assess the efficacy and safety of inferior implantation of the Xen Gel 45® Stent in a cohort of refractory glaucoma patients who had undergone multiple failed procedures and lacked healthy superior conjunctiva. Patients and methods: We retrospectively included individuals with refractory glaucoma who underwent implantation of a Xen 45® in the inferior quadrants of the conjunctiva. At the 12-month mark, two success criteria were assessed: u201cCompleteu201d success, defined as an intraocular pressure (IOP) ≤ 21 mmHg with a ≥ 20% reduction in IOP without additional IOP-lowering medications, the absence of a requirement for additional filtering surgery, and the absence of chronic hypotony; and u201cQualifiedu201d success, which consisted of patients meeting the same criteria but requiring glaucoma medications postoperatively. Safety was also monitored throughout the 12-month follow-up. Results: A total of 35 patients who underwent inferior Xen implantation were assessed. After 12 months, 20 patients (57.1%) achieved qualified success, with twelve patients (34.3%) attaining complete success. Excluding five patients who underwent additional filtering surgery during follow-up, the mean IOP decreased significantly from 30.73 ± 9.7 mmHg to 16.49 ± 7.9 mmHg, representing a mean decrease of 14.24 ± 12.13 mmHg (46.5%; P < 0.0001). The mean number of medications at 12 months decreased from 3.43 ± 1.6 to 1.53 ± 1.52 (−55.4%; P < 0.0001). The mean number of needlings was 1.29 ± 1.2. Implant exposure was observed in two patients during the first postoperative month. Conclusions: Inferior placement of Xen appears to be a viable treatment option for patients with refractory glaucoma and a history of multiple failed glaucoma procedures. It demonstrates both significant efficacy and acceptable safety.

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