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Xen-DS: a novel technique of ab externo Xen implantation augmented with a modified deep sclerectomy for surgical treatment of glaucoma

Eye (2024)Cite this article

Subjects

Abstract

Purpose

The Xen gel stent is a surgical glaucoma device which creates a subconjunctival filtering bleb, which has demonstrated good intraocular pressure (IOP) lowering and safety. Nonetheless, bleb-related problems have been reported. We present a case series of ab externo Xen procedures augmented with a deep intra-scleral lake, aiming to improve both IOP-lowering and post-operative management.

Methods

A retrospective review of 20 patients who underwent combined Xen gel stent implantation with modified deep sclerectomy at our institution from June to November 2022, with a 6-month follow-up period. We reviewed demographics, past ocular history, visual acuity (VA), IOP, visual fields, glaucoma medication use, complications, and perioperative information.

Results

20 eyes of 20 patients, with a mean age of 67.45 ± 14.38 underwent surgery. Pre-operative initial IOP was 24.5 ± 7.96 mmHg, improving to 11.50 ± 2.96 mmHg at 6 months; a change of −12.89 ± 8.34 mmHg and a mean decrease of 51.13 ± 20.15% (p < 0.0001) Patients were on 3.1 ± 0.72 glaucoma medications pre-operatively, improving to 0.72 ± 1.27 at 6 months (p < 0.0001). Visual field mean deviation was −13.99 ± 9.98 dB pre-operatively and −10.27 ± 9.06 dB at 6 months, with VA of 0.287 ± 0.69 pre-operatively and 0.31 ± 0.76 LogMAR post-operatively. No patients required bleb needling. 2 patients underwent subsequent bleb revision surgery. 2 patients developed choroidal effusions, which were managed conservatively with good visual outcomes.

Conclusion

In this preliminary study, we have found the modification of Xen gel stent implant surgery with a modified deep sclerectomy to offer good IOP lowering, with low rates of bleb needling and a good safety profile.

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Fig. 1: Surgical technique for combined Xen/scleral lake, as described in the text.
Fig. 2: Mean intraocular pressure pre-operatively, and at various post-operative time points.
Fig. 3: Mean number of glaucoma medications pre-operatively, and at various post-operative time points.
Fig. 4: Optical coherence tomography of the bleb following combined Xen gel stent insertion with modified deep sclerectomy, taken at 6-month follow-up.

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Data availability

Anonymised data can be offered on request.

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Authors and Affiliations

  1. University Hospital Southampton, Hampshire, UK

    A. Elbably, J. Richardson-May, N. Amerasinghe, R. Imonikhe, F. Stringa, S. Sampath & A. Jacob

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  1. A. Elbably
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Contributions

AE developed the technique, collected data, contributed to writing, reviewed the manuscript, and oversaw the project. JRM collected data and wrote the manuscript. NA, FS, RI, SS, and AJ contributed to writing and reviewing the manuscript.

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Correspondence to J. Richardson-May.

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Competing interests

NA has received consulting fees from AbbVie. There are no disclosures relevant to this work.

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This project was approved internally and as such no formal ethics committee discussion was sought. All patients provided informed consent.

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Elbably, A., Richardson-May, J., Amerasinghe, N. et al. Xen-DS: a novel technique of ab externo Xen implantation augmented with a modified deep sclerectomy for surgical treatment of glaucoma. Eye (2024). https://doi.org/10.1038/s41433-024-03146-6

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