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

Authors Tan NE, Tracer N, Terraciano A, Parikh HA, Panarelli JF, Radcliffe NM

Received 29 November 2020

Accepted for publication 8 January 2021

Published 26 January 2021 Volume 2021:15 Pages 299—305

DOI https://doi.org/10.2147/OPTH.S292007

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 5

Editor who approved publication: Dr Scott Fraser


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, USA

Correspondence: Nathan M Radcliffe
New York Eye Surgery Center, 1101 Pelham Parkway North, Bronx, NY, USA
Tel +1 718 519 1000
Email drradcliffe@gmail.com

Purpose: 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

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