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Is a Day 1 postoperative review following ab interno Xen gel stent surgery for glaucoma needed?

Authors Karimi A, Lindfield D

Received 26 July 2018

Accepted for publication 15 October 2018

Published 15 November 2018 Volume 2018:12 Pages 2331—2335

DOI https://doi.org/10.2147/OPTH.S181530

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser


Ayesha Karimi, Dan Lindfield

Department of Ophthalmology, Royal Surrey County Hospital, Guildford, UK

Purpose:
To assess whether a first day review is needed following Xen surgery in glaucoma patients.
Patients and methods: We performed a retrospective case note review of all Xen surgeries performed across four centers between August 2015 and May 2017. Intraocular pressure (IOP), number of medications, complications, and all further procedures were recorded.
Results: Two hundred and fifty-nine cases from 226 patients were analyzed, 78 of 259 cases (30.1%) had numerical hypotony (<6 mmHg) on Day 1, but 60 had resolved by Week 1. Zero cases of hypotony required intervention at Day 1. Two of 259 cases (0.8%) had transient IOP of ≥20 mmHg due to air bubble/iris blockage on Day 1 with one case (0.4%) requiring iris manipulation at the slit-lamp. One case (0.4%) required IOP lowering medications at Day 1. All other complications and interventions in our series occurred at 1 week or beyond. Day 1 IOP was not shown to be a reliable indicator for outcomes at Week 1 (r2=0.2155), Month 1 (r2=0.0574), or Month 12 (r2=0.1580).
Conclusion:
The presence of significant complications requiring intervention at Day 1 was 0%. Only one case (0.4%) required topical IOP lowering medication and one case (0.4%) needed stent manipulation at Day 1. Day 1 IOP is not a reliable indicator of long-term outcomes in Xen surgeries. Removing Day 1 follow-up would have been safe in our series and it may be more effective to perform the first postoperative review of Xen surgery at Week 1.

Keywords: ab interno, MIGS, gel stent, open angle

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