Three-year clinical outcome of XEN45 Gel Stent implantation versus trabeculectomy in patients with open angle glaucoma

Teresa Rauchegger; Sarah-Maria Krause; Yvonne Nowosielski; Anna Lena Huber; Peter Willeit; Eduard Schmid; Barbara Teuchner

doi:10.1038/s41433-024-03042-z

Three-year clinical outcome of XEN45 Gel Stent implantation versus trabeculectomy in patients with open angle glaucoma

Eye (Lond). 2024 Mar 28. doi: 10.1038/s41433-024-03042-z. Online ahead of print.

Authors

Teresa Rauchegger¹, Sarah-Maria Krause², Yvonne Nowosielski², Anna Lena Huber², Peter Willeit^{3

4}, Eduard Schmid², Barbara Teuchner²

Affiliations

¹ Department of Ophthalmology and Optometry, Medical University of Innsbruck, Innsbruck, Austria. teresa.rauchegger@i-med.ac.at.
² Department of Ophthalmology and Optometry, Medical University of Innsbruck, Innsbruck, Austria.
³ Institute of Health Economics, Medical University of Innsbruck, Innsbruck, Austria. peter.willeit@i-med.ac.at.
⁴ Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. peter.willeit@i-med.ac.at.

PMID: 38548944
DOI: 10.1038/s41433-024-03042-z

Abstract

Objective: To reliably compare the three-year clinical outcome and safety of XEN45 Gel Stent implantation (XEN) vs. trabeculectomy (TRAB) in patients with glaucoma.

Subject/methods: We conducted a retrospective cohort study with patients with primary open angle or pseudoexfoliation glaucoma with uncontrolled intraocular pressure (IOP) undergoing XEN or TRAB at the Innsbruck University Clinic of Ophthalmology and Optometry, Austria and analysed changes in IOP, numbers of IOP-lowering medications, and complete surgical success (i.e., IOP ≤ 18 mmHg, ≥20% IOP reduction and not requiring IOP-lowering medication) up to 36 months postoperatively.

Results: Between 2013 and 2019, we performed XEN Gel Stent implantation in 58 eyes and trabeculectomy in 84 eyes. From baseline to 36 months, mean IOP decreased from 23.4 to 13.8 mmHg (mean reduction 35%, 95% confidence interval 23-48%, p < 0.001) in the XEN group and from 25.1 to 11.2 mmHg (mean reduction 50%, 41-60%, p < 0.001) in the TRAB group. TRAB provided higher IOP reduction than XEN Gel Stent implantation at 12, 24, and 36 months (all p < 0.05). In XEN versus TRAB, IOP-lowering medication was required by 98.3% vs. 97.6% before surgery (p = 0.781), differed significantly at month 12 (43.2% vs. 2.0%, p < 0.001)but not at month 24 or 36. Complete surgical success was achieved in 40.0% vs. 62.8% at month 24 (adjusted odds ratio 2.70; 1.04-7.00, p = 0.040) and 27.3% vs. 56.8% at month 36 (4.36; 1.25-15.18, p = 0.021).

Conclusion: Compared to XEN, TRAB was associated with lower intraocular pressure, less IOP-lowering medication, and higher probability of achieving complete surgical success over a 36-month follow-up period.