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

Figures & data

Table 1 Patient demographics

Number of surgeries	259
Age, years
Mean (95% CI)	74.8 (73.4–76.2)
Range	37–96
Sex, n (%)
Male	144 (55.6)
Female	115 (44.4)
Ethnicity, n (%)
White	254 (98.1)
Asian Indian	3 (1.2)
Arab	2 (0.7)
Operated eye, n (%)
Right	130 (50.2)
Left	129 (49.8)
Preoperative IOP, mmHg
Mean (95% CI)	19.3 (18.5–20.0)
Range	5–40
Number of IOP lowering medications preoperatively
Mean (95% CI)	2.6 (2.5–2.7)
Range	0–4
Surgery type, n (%)
Xen	187 (72.2)
Xen + phacoemulsification	72 (27.8)
Previous glaucoma intervention, n (%)
Laser trabeculoplasty	72 (34.4)
Trabeculectomy	11 (4.2)
Valve/stent	7 (3.3)
Diagnoses, n (%)
OAG	208 (80.3)
NTG	17 (6.6)
PXF	13 (5.0)
PDS	6 (2.3)
Trauma	6 (2.3)
NVG	5 (1.9)
Iatrogenic	1 (0.4)
Others	3 (1.2)
Anesthesia, n (%)
Sub-Tenon’s	108 (41.7)
Topical + intracameral	53 (20.5)
Peribulbar	34 (13.1)
Unknown	64 (24.7)

Abbreviations: IOP, intraocular pressure; OAG, primary open angle glaucoma; NTG, normal tension glaucoma; PXF, pseudoexfoliation syndrome; PDS, pigment dispersion syndrome; NVG, neovascular glaucoma.

Figure 1 Scatter plot of Day 1 and Month 12 IOP for all Xen surgeries followed up to 12 months (n=83).

Note: Univariate linear regression analysis: r²=0.1580, P<0.0001.
Abbreviation: IOP, intraocular pressure.

Table 2 Frequency and timepoint of postoperative complications found following Xen surgery (n=259)

Complications	Day 1	Week 1	Month 1	Beyond Month 1
Numerical hypotony (IOP <6 mmHg)	78	9	1	2
IOP spike (≥30 mmHg)	0	6	10	17
Transient implant occlusion, eg, iris, blood (causing IOP ≥20 mmHg)	2	1	6	1
≥2 Snellen lines vision loss lasting >1 month	0	0	0	9
Large dysesthetic bleb	0	1	2	3
Implant exposure	0	0	3	3
Hypotonous maculopathy	3	1	1	0
Choroidal effusion lasting >1 month	0	0	0	4
Endophthalmitis	0	0	0	1
Central retinal vein occlusion	0	0	0	1

Abbreviation: IOP, intraocular pressure.

Table 3 Frequency and timepoint of further procedures or treatment required following Xen surgery (n=259)

Procedures	Day 1	Week 1	Month 1	Beyond Month 1
Bleb management (needling ± antimetabolite)	2a	21	75	129
Intraocular pressure lowering medications	1	20	46	136
Secondary filtration surgery	0	3	5	16
Xen/bleb revision surgery	0	0	5	11
Lancing of large bleb	0	0	5	4
Implant manipulation at slit-lamp	1	0	0	0
Slit-lamp reformation of the anterior chamber	0	1	0	1
Endoscopic cyclophotocoagulation	0	0	0	5
Iridoplasty/iridotomy	0	1	0	3
Selective laser trabeculoplasty	0	0	1	0
Micropulse laser trabeculoplasty	0	0	0	1
Laser gonioplasty	0	0	1	0

Note:

a Planned procedure scheduled prior to surgery due to severe conjunctival inflammation.

AroraKSRobinALCorcoranKJCorcoranSLRamuluPYUse of Various Glaucoma Surgeries and Procedures in Medicare Beneficiaries from 1994 to 2012Ophthalmol2015122816151624

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