XEN^® Gel Stent: A Comprehensive Review on Its Use as a Treatment Option for Refractory Glaucoma

References

• Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014;121(11):2081–2090. doi:10.1016/j.ophtha.2014.05.013
   PubMed Web of Science ®Google Scholar
• Leung EW, Medeiros FA, Weinreb RN. Prevalence of ocular surface disease in glaucoma patients. J Glaucoma. 2008;17(5):350–355. doi:10.1097/IJG.0b013e31815c5f4f
   PubMed Web of Science ®Google Scholar
• Fechtner RD, Godfrey DG, Budenz D, Stewart JA, Stewart WC, Jasek MC. Prevalence of ocular surface complaints in patients with glaucoma using topical intraocular pressure-lowering medications. Cornea. 2010;29(6):618–621. doi:10.1097/ICO.0b013e3181c325b2
   PubMed Web of Science ®Google Scholar
• Harasymowycz PJ, Papamatheakis DG, Latina M, De Leon M, Lesk MR, Damji KF. Selective laser trabeculoplasty (SLT) complicated by intraocular pressure elevation in eyes with heavily pigmented trabecular meshworks. Am J Ophthalmol. 2005;139(6):1110–1113. doi:10.1016/j.ajo.2004.11.038
   Web of Science ®Google Scholar
• Bettis DI, Whitehead JJ, Farhi P, Zabriskie NA. Intraocular pressure spike and corneal decompensation following selective laser trabeculoplasty in patients with exfoliation glaucoma. J Glaucoma. 2016;25(4):e433–437. doi:10.1097/IJG.0000000000000340
   PubMed Web of Science ®Google Scholar
• Kotecha A, Feuer WJ, Barton K, Gedde SJ. Quality of life in the tube versus trabeculectomy study. Am J Ophthalmol. 2017;176:228–235. doi:10.1016/j.ajo.2017.01.019
   PubMed Web of Science ®Google Scholar
• Gedde SJ, Singh K, Schiffman JC, Feuer WJ. The tube versus trabeculectomy study: interpretation of results and application to clinical practice. Curr Opin Ophthalmol. 2012;23(2):118–126. doi:10.1097/ICU.0b013e32834ff2d1
   PubMed Web of Science ®Google Scholar
• Pfeiffer N, Garcia-Feijoo J, Martinez-de-la-Casa JM, et al. A randomized trial of a schlemm’s canal microstent with phacoemulsification for reducing intraocular pressure in open-angle glaucoma. Ophthalmology. 2015;122(7):1283–1293. doi:10.1016/j.ophtha.2015.03.031
   PubMed Web of Science ®Google Scholar
• Hoeh H, Vold SD, Ahmed IK, et al. Initial clinical experience with the CyPass micro-stent: safety and surgical outcomes of a novel supraciliary microstent. J Glaucoma. 2016;25(1):106–112. doi:10.1097/IJG.0000000000000134
   PubMed Web of Science ®Google Scholar
• Lewis RA. Ab interno approach to the subconjunctival space using a collagen glaucoma stent. J Cataract Refract Surg. 2014;40(8):1301–1306. doi:10.1016/j.jcrs.2014.01.032
   PubMed Web of Science ®Google Scholar
• Fea AM, Ahmed II, Lavia C, et al. Hydrus microstent compared to selective laser trabeculoplasty in primary open angle glaucoma: one year results. Clin Exp Ophthalmol. 2017;45(2):120–127. doi:10.1111/ceo.12805
   PubMed Web of Science ®Google Scholar
• Sheybani A, Reitsamer H, Ahmed II. Fluid dynamics of a novel micro-fistula implant for the surgical treatment of glaucoma. Invest Ophthalmol Vis Sci. 2015;56(8):4789–4795. doi:10.1167/iovs.15-16625
   PubMed Web of Science ®Google Scholar
• Yu D-Y, Morgan WH, Sun X, et al. The critical role of the conjunctiva in glaucoma filtration surgery. Prog Retin Eye Res. 2009;28(5):303–328. doi:10.1016/j.preteyeres.2009.06.004
   Web of Science ®Google Scholar
• Sheybani A, Dick HB, Ahmed II. Early clinical results of a novel ab interno gel stent for the surgical treatment of open-angle glaucoma. J Glaucoma. 2016;25(7):e691–696. doi:10.1097/IJG.0000000000000352
   PubMed Web of Science ®Google Scholar
• Schlenker MB, Gulamhusein H, Conrad-Hengerer I, et al. Efficacy, safety, and risk factors for failure of standalone ab interno gelatin microstent implantation versus standalone trabeculectomy. Ophthalmology. 2017;124(11):1579–1588. doi:10.1016/j.ophtha.2017.05.004
   PubMed Web of Science ®Google Scholar
• Widder RA, Dietlein TS, Dinslage S, Kuhnrich P, Rennings C, Rossler G. The XEN45 Gel Stent as a minimally invasive procedure in glaucoma surgery: success rates, risk profile, and rates of re-surgery after 261 surgeries. Graefes Arch Clin Exp Ophthalmol. 2018;256(4):765–771. doi:10.1007/s00417-018-3899-7
   PubMed Web of Science ®Google Scholar
• Yu JTS, Au L. Conjunctival bleb compression as a treatment for hypotony post XEN45 implant in uveitic glaucoma. Eur J Ophthalmol. 2019;1120672119836339.
   Web of Science ®Google Scholar
• Sng CC, Wang J, Hau S, Htoon HM, Barton K. XEN-45 collagen implant for the treatment of uveitic glaucoma. Clin Exp Ophthalmol. 2018;46(4):339–345. doi:10.1111/ceo.13087
   PubMed Web of Science ®Google Scholar
• Sheybani A, Lenzhofer M, Hohensinn M, Reitsamer H, Ahmed IIK. Phacoemulsification combined with a new ab interno gel stent to treat open-angle glaucoma: pilot study. J Cataract Refract Surg. 2015;41(9):1905–1909. doi:10.1016/j.jcrs.2015.01.019
   PubMed Web of Science ®Google Scholar
• Lenzhofer M, Kersten-Gomez I, Sheybani A, et al. Four-year results of a minimally invasive transscleral glaucoma gel stent implantation in a prospective multi-centre study. Clin Exp Ophthalmol. 2019;47(5):581–587. doi:10.1111/ceo.13463
   PubMed Web of Science ®Google Scholar
• Tan SZ, Walkden A, Au L. One-year result of XEN45 implant for glaucoma: efficacy, safety, and postoperative management. Eye (Lond). 2018;32(2):324–332. doi:10.1038/eye.2017.162
   Web of Science ®Google Scholar
• Grover DS, Flynn WJ, Bashford KP, et al. Performance and safety of a new Ab interno gelatin stent in refractory glaucoma at 12 months. Am J Ophthalmol. 2017;183:25–36. doi:10.1016/j.ajo.2017.07.023
   PubMed Web of Science ®Google Scholar
• Perez-Torregrosa VT, Olate-Perez A, Cerda-Ibanez M, et al. Combined phacoemulsification and XEN45 surgery from a temporal approach and 2 incisions. Arch Soc Esp Oftalmol. 2016;91(9):415–421. doi:10.1016/j.oftal.2016.02.006
   PubMedGoogle Scholar
• De Gregorio A, Pedrotti E, Russo L, Morselli S. Minimally invasive combined glaucoma and cataract surgery: clinical results of the smallest ab interno gel stent. Int Ophthalmol. 2018;38(3):1129–1134. doi:10.1007/s10792-017-0571-x
   PubMed Web of Science ®Google Scholar
• Hengerer FH, Kohnen T, Mueller M, Ab Interno C-HI. Gel implant for the treatment of glaucoma patients with or without prior glaucoma surgery: 1-year results. J Glaucoma. 2017;26(12):1130–1136. doi:10.1097/IJG.0000000000000803
   PubMed Web of Science ®Google Scholar
• Ozal SA, Kaplaner O, Basar BB, Guclu H, Ozal E. An innovation in glaucoma surgery: XEN45 gel stent implantation. Arq Bras Oftalmol. 2017;80(6):382–385. doi:10.5935/0004-2749.20170093
   Web of Science ®Google Scholar
• Heidinger A, Schwab C, Lindner E, Riedl R, Mossbock G, Retrospective A. Study of 199 Xen45 stent implantations from 2014 to 2016. J Glaucoma. 2019;28(1):75–79. doi:10.1097/IJG.0000000000001122
   PubMed Web of Science ®Google Scholar
• Karimi A, Lindfield D, Turnbull A, et al. A multi-centre interventional case series of 259 ab-interno Xen gel implants for glaucoma, with and without combined cataract surgery. Eye (Lond). 2019;33(3):469–477. doi:10.1038/s41433-018-0243-8
   PubMed Web of Science ®Google Scholar
• Galal A, Bilgic A, Eltanamly R, Osman A. XEN glaucoma implant with mitomycin C 1-year follow-up: result and complications. J Ophthalmol. 2017;2017:5457246. doi:10.1155/2017/5457246
   PubMed Web of Science ®Google Scholar
• Mansouri K, Guidotti J, Rao HL, et al. Prospective evaluation of standalone XEN gel implant and combined phacoemulsification-XEN gel implant surgery: 1-year results. J Glaucoma. 2018;27(2):140–147. doi:10.1097/IJG.0000000000000858
   PubMed Web of Science ®Google Scholar
• Hohberger B, Welge-Lussen UC, Lammer R. MIGS: therapeutic success of combined Xen Gel Stent implantation with cataract surgery. Graefes Arch Clin Exp Ophthalmol. 2018;256(3):621–625. doi:10.1007/s00417-017-3895-3
   PubMed Web of Science ®Google Scholar
• Reitsamer H, Sng C, Vera V, Lenzhofer M, Barton K, Stalmans I. Two-year results of a multicenter study of the ab interno gelatin implant in medically uncontrolled primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol. 2019;257(5):983–996. doi:10.1007/s00417-019-04251-z
   PubMed Web of Science ®Google Scholar
• Fea AM, Bron AM, Economou MA, et al. A real-life prospective study on the efficacy of the XEN 45 stent: a European study. J Cataract Refract Surg. 2020.
   Web of Science ®Google Scholar
• Ibanez-Munoz A, Soto-Biforcos VS, Chacon-Gonzalez M, et al. One-year follow-up of the XEN(R) implant with mitomycin-C in pseudoexfoliative glaucoma patients. Eur J Ophthalmol. 2019;29(3):309–314. doi:10.1177/1120672118795063
   Web of Science ®Google Scholar
• Mansouri K, Gillmann K, Rao HL, Guidotti J, Mermoud A. Prospective evaluation of XEN gel implant in eyes with pseudoexfoliative glaucoma. J Glaucoma. 2018;27(10):869–873. doi:10.1097/IJG.0000000000001045
   PubMed Web of Science ®Google Scholar
• Gillmann K, Bravetti GE, Mermoud A, Rao HL, Mansouri K. XEN gel stent in pseudoexfoliative glaucoma: 2-year results of a prospective evaluation. J Glaucoma. 2019;28(8):676–684. doi:10.1097/IJG.0000000000001295
   PubMed Web of Science ®Google Scholar
• Qureshi A, Jones NP, Au L. Urgent management of secondary glaucoma in uveitis using the Xen-45 gel stent. J Glaucoma. 2019;28(12):1061–1066. doi:10.1097/IJG.0000000000001389
   PubMed Web of Science ®Google Scholar
• Lin MM, Morgan WH, Kolomeyer NN, et al. XEN gel stent to treat ICE syndrome: 4 cases. J Glaucoma. 2019;28(12):1090–1094. doi:10.1097/IJG.0000000000001341
   Web of Science ®Google Scholar
• Hohberger B, Welge-Luen UC, Lammer R. ICE-syndrome: a case report of implantation of a microbypass xen gel stent after DMEK transplantation. J Glaucoma. 2017;26(2):e103–e104. doi:10.1097/IJG.0000000000000584
   Web of Science ®Google Scholar
• Rezkallah A, Mathis T, Denis P, Kodjikian L. XEN gel stent to treat intraocular hypertension after dexamethasone-implant intravitreal injections: 5 cases. J Glaucoma. 2019;28(1):e5–e9. doi:10.1097/IJG.0000000000001092
   PubMed Web of Science ®Google Scholar
• Smith OU, Grover DS, Emanuel ME, Godfrey DG, Fellman RL. XEN gel stent in pediatric glaucoma. J Glaucoma. 2020;29(4):e19–e22. doi:10.1097/IJG.0000000000001453
   PubMed Web of Science ®Google Scholar
• Ferreira NP, Pinto JM, Teixeira F, Pinto LA, Gel Stent XEN. Early failure-dye-enhanced Ab-externo revision. J Curr Glaucoma Pract. 2018;12(3):139–141. doi:10.5005/jp-journals-10078-1237
   Google Scholar
• Olivari S, Cutolo CA, Negri L, et al. XEN implant fracture during needling procedure. J Glaucoma. 2019;28(12):1086–1089. doi:10.1097/IJG.0000000000001360
   Web of Science ®Google Scholar
• Bustros Y, Chaudhary A, Salinas L, Mansouri K. Cutting the subconjunctival fragment of the XEN gel implant during needling procedure. Eur J Ophthalmol. 2020;30(1):Np11–np15. doi:10.1177/1120672118805876
   Web of Science ®Google Scholar
• Midha N, Gillmann K, Chaudhary A, Mermoud A, Mansouri K. Efficacy of needling revision after XEN gel stent implantation: a prospective study. J Glaucoma. 2020;29(1):11–14. doi:10.1097/IJG.0000000000001394
   PubMed Web of Science ®Google Scholar
• Karimi A, Hopes M, Martin KR, Lindfield D. Efficacy and safety of the Ab-interno Xen gel stent after failed trabeculectomy. J Glaucoma. 2018;27(10):864–868. doi:10.1097/IJG.0000000000001044
   Web of Science ®Google Scholar
• Gizzi C, Mohamed-Noriega J, Elkarmouty A, Scott A. Trabeculectomy following failed Ab interno gelatin microstent: case series. J Glaucoma. 2018;27(10):e168–e173. doi:10.1097/IJG.0000000000001000
   Web of Science ®Google Scholar
• Fea AM, Spinetta R, Cannizzo PML, et al. Evaluation of Bleb morphology and reduction in IOP and glaucoma medication following implantation of a novel gel stent. J Ophthalmol. 2017;2017:9364910. doi:10.1155/2017/9364910
   PubMed Web of Science ®Google Scholar
• Lenzhofer M, Strohmaier C, Hohensinn M, et al. Longitudinal bleb morphology in anterior segment OCT after minimally invasive transscleral ab interno Glaucoma Gel Microstent implantation. Acta Ophthalmol. 2019;97(2):e231–e237. doi:10.1111/aos.14167
   PubMed Web of Science ®Google Scholar
• Midha N, Rao HL, Mermoud A, Mansouri K. Identifying the predictors of needling after XEN gel implant. Eye (Lond). 2019;33(3):353–357. doi:10.1038/s41433-018-0206-0
   PubMed Web of Science ®Google Scholar
• Gillmann K, Bravetti GE, Rao HL, Mermoud A, Mansouri K. Impact of combined XEN gel stent implantation on corneal endothelial cell density: 2-year results. J Glaucoma. 2019;28(6):e93–e95. doi:10.1097/IJG.0000000000001200
   Web of Science ®Google Scholar
• Dervenis N, Mikropoulou AM, Dervenis P, Lewis A. Dislocation of a previously successful XEN glaucoma implant into the anterior chamber: a case report. BMC Ophthalmol. 2017;17(1):148. doi:10.1186/s12886-017-0540-1
   Web of Science ®Google Scholar
• Yavuzer K, Mesen A. The treatment of a hypertrophic bleb after XEN gel implantation with the “Drainage channel with sutures” method: a case report. BMC Ophthalmol. 2019;19(1):245. doi:10.1186/s12886-019-1249-0
   Web of Science ®Google Scholar
• Sandhu S, Dorey MW. Case report: xen Ab interno gel stent use in a refractory glaucoma patient with previous filtration surgeries. J Glaucoma. 2018;27(3):e59–e60. doi:10.1097/IJG.0000000000000864
   Web of Science ®Google Scholar
• Tailor R, Lalias TA. Case of refractory neovascular glaucoma treated with a XEN 45 implant. J Glaucoma. 2018;27(10):929–930. doi:10.1097/IJG.0000000000001033
   Web of Science ®Google Scholar
• Karri B, Gupta C, Mathews D. Endophthalmitis Following XEN Stent Exposure. J Glaucoma. 2018;27(10):931–933. doi:10.1097/IJG.0000000000001012
   Web of Science ®Google Scholar
• Olgun A, Imamoglu S, Karapapak M, Duzgun E, Kacar H. Endophthalmitis after XEN gel stent implantation: 2 cases. J Glaucoma. 2018;27(12):e191–e194. doi:10.1097/IJG.0000000000001076
   PubMed Web of Science ®Google Scholar
• Rigo J, Castany M, Banderas S, Pujol O, Amilburu M, Dou A. Possible intraluminal obstruction of the XEN45 gel stent observed with anterior segment optical coherence tomography. J Glaucoma. 2019;28(12):1095–1101. doi:10.1097/IJG.0000000000001351
   PubMed Web of Science ®Google Scholar
• Prokosch-Willing V, Vossmerbaeumer U, Hoffmann E, Pfeiffer N. Suprachoroidal bleeding after XEN gel implantation. J Glaucoma. 2017;26(12):e261–e263. doi:10.1097/IJG.0000000000000795
   Web of Science ®Google Scholar
• Rezkallah A, Mathis T, Denis P, Kodjikian L. XEN gel stent: a total delayed-onset postoperative hyphema. Int J Ophthalmol. 2019;12(7):1224–1226. doi:10.18240/ijo.2019.07.27
   Web of Science ®Google Scholar
• Widder RA, Kuhnrich P, Hild M, Rennings C, Szumniak A, Rossler GF. Intraocular degradation of XEN45 gel stent 3 years after its implantation. J Glaucoma. 2019;28(12):e171–e173. doi:10.1097/IJG.0000000000001364
   PubMed Web of Science ®Google Scholar
• Lapira M, Cronbach N, Shaikh A. Extrusion and breakage of XEN gel stent resulting in endophthalmitis. J Glaucoma. 2018;27(10):934–935. doi:10.1097/IJG.0000000000001058
   PubMed Web of Science ®Google Scholar
• Arnould L, Theillac V, Moran S, Gatinel D, Grise-Dulac G-DA. Recurrent exposure of XEN gel stent implant and conjunctival erosion. J Glaucoma. 2019;28(3):e37–e40. doi:10.1097/IJG.0000000000001146
   Web of Science ®Google Scholar
• Fea A, Cannizzo PM, Consolandi G, Lavia CA, Pignata G, Grignolo FM. Managing drawbacks in unconventional successful glaucoma surgery: a case report of stent exposure. Case Rep Ophthalmol Med. 2015;2015:847439.
   PubMedGoogle Scholar
• Salinas L, Chaudhary A, Guidotti J, Mermoud A, Mansouri K. Revision of a leaking bleb with XEN gel stent replacement. J Glaucoma. 2018;27(1):e11–e13. doi:10.1097/IJG.0000000000000811
   Web of Science ®Google Scholar