Learning Curve and One-Year Outcome of XEN 45 Gel Stent Implantation in a Swedish Population

Tobias Busch,1 Dragana Skiljic,1,2 Thiemo Rudolph,1 Anders Bergström,1,3 Madeleine Zetterberg1,2 1Department of Ophthalmology, Region Västra Götaland, Sahlgrenska University Hospital, Mölndal, Sweden; 2Department of Clinical Neuroscience, Institute of Neuroscience...

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Autores principales:	Busch T, Skiljic D, Rudolph T, Bergström A, Zetterberg M
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	glaucoma minimal invasive glaucoma surgery migs pseudoexfoliative glaucoma xen 45 gel stent ab interno implant surgical success Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/96f47ad21ae94fc4adcb86563c8f4f51
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spelling	oai:doaj.org-article:96f47ad21ae94fc4adcb86563c8f4f512021-12-02T13:37:45ZLearning Curve and One-Year Outcome of XEN 45 Gel Stent Implantation in a Swedish Population1177-5483https://doaj.org/article/96f47ad21ae94fc4adcb86563c8f4f512020-11-01T00:00:00Zhttps://www.dovepress.com/learning-curve-and-one-year-outcome-of-xen-45-gel-stent-implantation-i-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Tobias Busch,1 Dragana Skiljic,1,2 Thiemo Rudolph,1 Anders Bergström,1,3 Madeleine Zetterberg1,2 1Department of Ophthalmology, Region Västra Götaland, Sahlgrenska University Hospital, Mölndal, Sweden; 2Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 3Department of Ophthalmology, Skåne University Hospital, Lund, SwedenCorrespondence: Tobias BuschDepartment of Ophthalmology, Region Västra Götaland, Sahlgrenska University Hospital, SE-431 80, Mölndal, SwedenTel +46 0 31342 10 00Fax +46 0 31 41 29 04Email tobias.busch@vgregion.sePurpose: Evaluation of 1-year-outcome of XEN 45 gel stent surgery in a Swedish cohort with regard to clinical success, complications, and learning curve.Patients and Methods: This was a retrospective study of glaucoma patients undergoing glaucoma XEN-stent surgery alone or combined with phacoemulsification between December 2015 and May 2017. Intraocular pressure (IOP), number of medical agents, and adverse events were assessed. Clinical success rate was defined as achieving individual target pressure with/without medication.Results: A total of 113 eyes were included in the final statistics. Mean age was 70.8± 11.8 years. Primary open angle glaucoma (POAG) accounted for 46.9% and exfoliative glaucoma (PEXG) for 40.7%. Mean preoperative IOP was 23.8± 6.2 mmHg and mean number of agents 3.4. After 1 year, mean IOP was reduced to 16.1± 4.7 mmHg and medication to 1.34 substances on average. Failure rate at 1-year follow-up was 34% with no significant difference between POAG and PEXG. There was a trend of higher success rate for combined cases (P=0.116). Stents with malpositioned or curved appearance had significantly worse outcome. The failure rate of the most productive surgeon dropped from 33% to 10% from the first implantations. Temporary hypotony (19.5%) and choroidal detachment (9.7%) were the most common complications. Blockage of the inner stent lumen was common (8.8%), with a high proportion of failure.Conclusion: XEN-stent surgery is a surgical option in uncontrolled glaucoma in both POAG and PEXG. A XEN-stent can reduce both IOP and the number of antiglaucoma medications needed. The learning curve is significant and stent positioning is crucial for optimal results. Combined XEN-cataract surgery is not inferior to stand-alone procedures. The long-time effectiveness is still to be proven.Keywords: glaucoma, minimal invasive glaucoma surgery, MIGS, pseudoexfoliative glaucoma, XEN 45 gel stent, Ab interno implant, surgical successBusch TSkiljic DRudolph TBergström AZetterberg MDove Medical Pressarticleglaucomaminimal invasive glaucoma surgery migspseudoexfoliative glaucomaxen 45 gel stentab interno implantsurgical successOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 14, Pp 3719-3733 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	glaucoma minimal invasive glaucoma surgery migs pseudoexfoliative glaucoma xen 45 gel stent ab interno implant surgical success Ophthalmology RE1-994
spellingShingle	glaucoma minimal invasive glaucoma surgery migs pseudoexfoliative glaucoma xen 45 gel stent ab interno implant surgical success Ophthalmology RE1-994 Busch T Skiljic D Rudolph T Bergström A Zetterberg M Learning Curve and One-Year Outcome of XEN 45 Gel Stent Implantation in a Swedish Population
description	Tobias Busch,1 Dragana Skiljic,1,2 Thiemo Rudolph,1 Anders Bergström,1,3 Madeleine Zetterberg1,2 1Department of Ophthalmology, Region Västra Götaland, Sahlgrenska University Hospital, Mölndal, Sweden; 2Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 3Department of Ophthalmology, Skåne University Hospital, Lund, SwedenCorrespondence: Tobias BuschDepartment of Ophthalmology, Region Västra Götaland, Sahlgrenska University Hospital, SE-431 80, Mölndal, SwedenTel +46 0 31342 10 00Fax +46 0 31 41 29 04Email tobias.busch@vgregion.sePurpose: Evaluation of 1-year-outcome of XEN 45 gel stent surgery in a Swedish cohort with regard to clinical success, complications, and learning curve.Patients and Methods: This was a retrospective study of glaucoma patients undergoing glaucoma XEN-stent surgery alone or combined with phacoemulsification between December 2015 and May 2017. Intraocular pressure (IOP), number of medical agents, and adverse events were assessed. Clinical success rate was defined as achieving individual target pressure with/without medication.Results: A total of 113 eyes were included in the final statistics. Mean age was 70.8± 11.8 years. Primary open angle glaucoma (POAG) accounted for 46.9% and exfoliative glaucoma (PEXG) for 40.7%. Mean preoperative IOP was 23.8± 6.2 mmHg and mean number of agents 3.4. After 1 year, mean IOP was reduced to 16.1± 4.7 mmHg and medication to 1.34 substances on average. Failure rate at 1-year follow-up was 34% with no significant difference between POAG and PEXG. There was a trend of higher success rate for combined cases (P=0.116). Stents with malpositioned or curved appearance had significantly worse outcome. The failure rate of the most productive surgeon dropped from 33% to 10% from the first implantations. Temporary hypotony (19.5%) and choroidal detachment (9.7%) were the most common complications. Blockage of the inner stent lumen was common (8.8%), with a high proportion of failure.Conclusion: XEN-stent surgery is a surgical option in uncontrolled glaucoma in both POAG and PEXG. A XEN-stent can reduce both IOP and the number of antiglaucoma medications needed. The learning curve is significant and stent positioning is crucial for optimal results. Combined XEN-cataract surgery is not inferior to stand-alone procedures. The long-time effectiveness is still to be proven.Keywords: glaucoma, minimal invasive glaucoma surgery, MIGS, pseudoexfoliative glaucoma, XEN 45 gel stent, Ab interno implant, surgical success
format	article
author	Busch T Skiljic D Rudolph T Bergström A Zetterberg M
author_facet	Busch T Skiljic D Rudolph T Bergström A Zetterberg M
author_sort	Busch T
title	Learning Curve and One-Year Outcome of XEN 45 Gel Stent Implantation in a Swedish Population
title_short	Learning Curve and One-Year Outcome of XEN 45 Gel Stent Implantation in a Swedish Population
title_full	Learning Curve and One-Year Outcome of XEN 45 Gel Stent Implantation in a Swedish Population
title_fullStr	Learning Curve and One-Year Outcome of XEN 45 Gel Stent Implantation in a Swedish Population
title_full_unstemmed	Learning Curve and One-Year Outcome of XEN 45 Gel Stent Implantation in a Swedish Population
title_sort	learning curve and one-year outcome of xen 45 gel stent implantation in a swedish population
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/96f47ad21ae94fc4adcb86563c8f4f51
work_keys_str_mv	AT buscht learningcurveandoneyearoutcomeofxen45gelstentimplantationinaswedishpopulation AT skiljicd learningcurveandoneyearoutcomeofxen45gelstentimplantationinaswedishpopulation AT rudolpht learningcurveandoneyearoutcomeofxen45gelstentimplantationinaswedishpopulation AT bergstroma learningcurveandoneyearoutcomeofxen45gelstentimplantationinaswedishpopulation AT zetterbergm learningcurveandoneyearoutcomeofxen45gelstentimplantationinaswedishpopulation
_version_	1718392688770809856

Learning Curve and One-Year Outcome of XEN 45 Gel Stent Implantation in a Swedish Population

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