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

Abstract

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

Acknowledgments

We are very thankful to Pieter Gouws who acquired the data at Conquest Hospital; Andrew Turnbull, Abdul Hanifudin, Nishani Amerasinghe, and Aby Jacob who acquired the data at University Hospital Southampton; and Chrys Dimitriou, Bhairavi Bhatia, and Mahmoud Radwan who acquired the data at Essex County Hospital.

Author contributions

Both authors contributed towards study design, data acquisition and analysis, drafting and critically revising the paper, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

DL reports previously receiving honoraria from Allergan, Alcon, Endo Optiks, Thea, MSD, BVI Visitec, and Santen as well as serving on the advisory panel for Allergan outside of this work. The authors report no other conflicts of interest in this work.