Comparison of Safety and Efficacy Between Ab Interno and Ab Externo Approaches to XEN Gel Stent Placement

Nicholas E Tan,1 Nathaniel Tracer,2 Anthony Terraciano,3 Hardik A Parikh,2 Joseph F Panarelli,2 Nathan M Radcliffe4,5 1College of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA; 2Department of Ophthalmology, NYU Langone Health, New York, NY, USA; 3Coll...

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Autores principales:	Tan NE, Tracer N, Terraciano A, Parikh HA, Panarelli JF, Radcliffe NM
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	migs glaucoma surgery bleb subconjunctival stent surgical technique Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/15df27bffba24176bca457bb571e7749
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spelling	oai:doaj.org-article:15df27bffba24176bca457bb571e77492021-12-02T12:45:19ZComparison of Safety and Efficacy Between Ab Interno and Ab Externo Approaches to XEN Gel Stent Placement1177-5483https://doaj.org/article/15df27bffba24176bca457bb571e77492021-01-01T00:00:00Zhttps://www.dovepress.com/comparison-of-safety-and-efficacy-between-ab-interno-and-ab-externo-ap-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Nicholas E Tan,1 Nathaniel Tracer,2 Anthony Terraciano,3 Hardik A Parikh,2 Joseph F Panarelli,2 Nathan M Radcliffe4,5 1College of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA; 2Department of Ophthalmology, NYU Langone Health, New York, NY, USA; 3College of Arts and Sciences, Vanderbilt University, Nashville, TN, USA; 4Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY, USA; 5New York Eye Surgery Center, Bronx, NY, USACorrespondence: Nathan M RadcliffeNew York Eye Surgery Center, 1101 Pelham Parkway North, Bronx, NY, USATel +1 718 519 1000Email drradcliffe@gmail.comPurpose: To compare the safety and efficacy of two different techniques for implantation of the XEN Gel Stent, a minimally invasive surgical device for the treatment of refractory glaucoma.Methods: A retrospective chart review of eyes that received ab interno or ab externo XEN Gel Stent placement from February 2017 to October 2019 was conducted. A single surgeon (NMR) performed all operations. Eyes that received the XEN implant concomitant with a glaucoma drainage device insertion or that were lost to 6-month follow-up were excluded. Intraocular pressure (IOP) change, change in glaucoma medications, frequency of slit lamp revision procedures, and frequency of secondary glaucoma surgeries were the primary outcomes compared between groups.Results: Fifty eyes that underwent ab interno placement and 30 eyes that underwent ab externo placement were studied. The ab interno cohort demonstrated a mean IOP reduction of 8.4 ± 1.7 mmHg (28.6% decrease) by 12 months, compared to a mean reduction of 12.8 ± 3.0 mmHg (40.1% decrease) in the ab externo group (p = 0.208). Mean reduction in medication use was 1.81 ± 0.29 medications in the ab interno group and 1.86 ± 0.37 in the ab externo group (p = 0.913). By 12 months, 58% of ab interno eyes had required 5-fluorouracil injection compared to 36.7% of ab externos (p = 0.105). Bleb needling was applied to 42% and 26.7% of the eyes, respectively (p = 0.231). A second glaucoma surgery was necessary for 20% of the ab interno cohort and 10% of the ab externo cohort (p = 0.351).Conclusion: There were no differences in outcomes between ab interno and ab externo placement of the XEN Gel Stent. Both approaches are safe and effective for lowering IOP.Keywords: MIGS, glaucoma surgery, bleb, subconjunctival stent, surgical techniqueTan NETracer NTerraciano AParikh HAPanarelli JFRadcliffe NMDove Medical Pressarticlemigsglaucoma surgeryblebsubconjunctival stentsurgical techniqueOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 15, Pp 299-305 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	migs glaucoma surgery bleb subconjunctival stent surgical technique Ophthalmology RE1-994
spellingShingle	migs glaucoma surgery bleb subconjunctival stent surgical technique Ophthalmology RE1-994 Tan NE Tracer N Terraciano A Parikh HA Panarelli JF Radcliffe NM Comparison of Safety and Efficacy Between Ab Interno and Ab Externo Approaches to XEN Gel Stent Placement
description	Nicholas E Tan,1 Nathaniel Tracer,2 Anthony Terraciano,3 Hardik A Parikh,2 Joseph F Panarelli,2 Nathan M Radcliffe4,5 1College of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA; 2Department of Ophthalmology, NYU Langone Health, New York, NY, USA; 3College of Arts and Sciences, Vanderbilt University, Nashville, TN, USA; 4Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY, USA; 5New York Eye Surgery Center, Bronx, NY, USACorrespondence: Nathan M RadcliffeNew York Eye Surgery Center, 1101 Pelham Parkway North, Bronx, NY, USATel +1 718 519 1000Email drradcliffe@gmail.comPurpose: To compare the safety and efficacy of two different techniques for implantation of the XEN Gel Stent, a minimally invasive surgical device for the treatment of refractory glaucoma.Methods: A retrospective chart review of eyes that received ab interno or ab externo XEN Gel Stent placement from February 2017 to October 2019 was conducted. A single surgeon (NMR) performed all operations. Eyes that received the XEN implant concomitant with a glaucoma drainage device insertion or that were lost to 6-month follow-up were excluded. Intraocular pressure (IOP) change, change in glaucoma medications, frequency of slit lamp revision procedures, and frequency of secondary glaucoma surgeries were the primary outcomes compared between groups.Results: Fifty eyes that underwent ab interno placement and 30 eyes that underwent ab externo placement were studied. The ab interno cohort demonstrated a mean IOP reduction of 8.4 ± 1.7 mmHg (28.6% decrease) by 12 months, compared to a mean reduction of 12.8 ± 3.0 mmHg (40.1% decrease) in the ab externo group (p = 0.208). Mean reduction in medication use was 1.81 ± 0.29 medications in the ab interno group and 1.86 ± 0.37 in the ab externo group (p = 0.913). By 12 months, 58% of ab interno eyes had required 5-fluorouracil injection compared to 36.7% of ab externos (p = 0.105). Bleb needling was applied to 42% and 26.7% of the eyes, respectively (p = 0.231). A second glaucoma surgery was necessary for 20% of the ab interno cohort and 10% of the ab externo cohort (p = 0.351).Conclusion: There were no differences in outcomes between ab interno and ab externo placement of the XEN Gel Stent. Both approaches are safe and effective for lowering IOP.Keywords: MIGS, glaucoma surgery, bleb, subconjunctival stent, surgical technique
format	article
author	Tan NE Tracer N Terraciano A Parikh HA Panarelli JF Radcliffe NM
author_facet	Tan NE Tracer N Terraciano A Parikh HA Panarelli JF Radcliffe NM
author_sort	Tan NE
title	Comparison of Safety and Efficacy Between Ab Interno and Ab Externo Approaches to XEN Gel Stent Placement
title_short	Comparison of Safety and Efficacy Between Ab Interno and Ab Externo Approaches to XEN Gel Stent Placement
title_full	Comparison of Safety and Efficacy Between Ab Interno and Ab Externo Approaches to XEN Gel Stent Placement
title_fullStr	Comparison of Safety and Efficacy Between Ab Interno and Ab Externo Approaches to XEN Gel Stent Placement
title_full_unstemmed	Comparison of Safety and Efficacy Between Ab Interno and Ab Externo Approaches to XEN Gel Stent Placement
title_sort	comparison of safety and efficacy between ab interno and ab externo approaches to xen gel stent placement
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/15df27bffba24176bca457bb571e7749
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Comparison of Safety and Efficacy Between Ab Interno and Ab Externo Approaches to XEN Gel Stent Placement

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