Cataract and glaucoma combined surgery: XEN® gel stent versus nonpenetrating deep sclerectomy, a pilot study

• Published in: BMC ophthalmology Vol. 20; no. 1; p. 231
• Main Authors: Theillac, Vincent, Blumen-Ohana, Esther, Akesbi, Jad, Hamard, Pascale, Sellam, Alexandre, Brasnu, Emmanuelle, Baudouin, Christophe, Labbe, Antoine, Nordmann, Jean-Philippe
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16.06.2020; BioMed Central; BMC
• Subjects: Acuity; Aged; Cataract; Cataract - complications; Cataract extraction; Cataract Extraction - methods; Cataracts; Combined surgery; Comparative analysis; Female; Follow-Up Studies; Gels; Glaucoma; Glaucoma, Open-Angle - complications; Glaucoma, Open-Angle - physiopathology; Glaucoma, Open-Angle - surgery; Human health and pathology; Humans; Implants; Life Sciences; Male; Microinvasive glaucoma surgery; Mitomycin; Mitomycin C; Nonpenetrating deep sclerectomy; Older people; Ophthalmic agents; Ophthalmology; Pilot Projects; Primary open angle glaucoma; Prosthesis Design; Prosthesis Implantation - methods; Retrospective Studies; Sclerostomy - methods; Sensory Organs; Software; Stents; Surgery; Surgical outcomes; Sutures; Treatment Outcome; Viscoelasticity; XEN; France; United States > US; XEN; Cataract; Combined surgery; Nonpenetrating deep sclerectomy; Microinvasive glaucoma surgery; Primary open angle glaucoma
• ISSN: 1471-2415; 1471-2415
• DOI: 10.1186/s12886-020-01492-z

To compare the efficacy of phacoemulsification (PKE) combined with nonpenetrating deep sclerectomy (NPDS) with mitomycin C (MMC) versus XEN® gel stent with MMC. In this nonrandomized, retrospective, comparative, single-center pilot study, 105 consecutive eyes of 75 patients with uncontrolled primary open-angle glaucoma (POAG) and cataract who underwent PKE combined with either XEN implantation (n = 47) or NPDS (n = 58) between May 2013 and November 2018 were included. The primary outcome was complete success at 9 months, which was defined as intraocular pressure (IOP) ≤18, 15 or 12 mmHg without treatment; qualified success was IOP ≤18, 15 or 12 mmHg with antiglaucoma medications. Secondary outcome measures included the number of antiglaucoma medications, visual acuity (VA), and postoperative adverse events. Using the 18 mmHg threshold, complete or qualified success was achieved in 69.6 and 89.1% in the PKE + XEN group, and 63.8 and 89.7% in the PKE + NPDS group (p = .54 and p = .93), respectively, at 9 months. The mean IOP decreased from 20.8 ± 6.8 mmHg to 16.2 ± 2.8 mmHg in the PKE + XEN group (p < .001, 18.9% mean drop), and from 21.5 ± 8.9 mmHg to 14.9 ± 3.9 mmHg in the PKE + NPDS group (p < .001, 25.6% mean drop). Best-corrected VA significantly improved (p < .001) in both groups. The mean number of antiglaucoma medications was significantly reduced from 2.66 ± 1.1 to 0.49 ± 1.0 in the PKE + XEN group (p < .001) and from 2.93 ± 0.9 to 0.69 ± 1.2 in the PKE + NPDS group (p < .001). The XEN stent combined with PKE seemed to be as effective and safe as PKE + NPDS at 9 months in this pilot study.