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Standalone XEN45 Gel Stent implantation versus combined XEN45-phacoemulsification in the treatment of open angle glaucoma—a systematic review and meta-analysis

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Abstract

Purpose

The XEN45 Gel Stent is currently the only FDA-approved sub-conjunctival minimally invasive glaucoma surgery (MIGS) procedure. It has been used worldwide either as a standalone implantation procedure or in combination with phacoemulsification surgery. Concomitant phacoemulsification is understood to influence outcomes of traditional subconjunctival filtering surgery. However, the comparative efficacy between standalone XEN45 Gel Sent implantation (“Standalone XEN45”) and combined XEN-phacoemulsification surgery (“XEN45-Phaco”) remains unclear. This study aims to appraise current literature to compare the efficacy of Standalone XEN45 and XEN45-Phaco in open-angle glaucoma.

Methods

A comprehensive search of PubMed, CINAHL, CENTRAL databases was performed with the terms “Xen surgery” followed by selective vetting. Pilot, cohort, observational studies and randomised controlled trials that included at least 10 patients undergoing either Standalone XEN45 or XEN45-Phaco surgeries for the treatment of open-angle glaucoma were deemed eligible for inclusion after independent assessment by 2 authors. The search workflow was reported according to the PRISMA guidelines. Data was pooled using random-effects model. A meta-analysis of continuous outcome and proportions was performed using the meta routine in R v3.2.1.

Results

Ten studies were included. There was a statistically significant difference in IOP reduction favouring Standalone XEN45 at post-operative day 1, week 1, months 1, 3 and 6. There was a statistically significant difference in decrease in IOP-lowering medications favouring Standalone XEN45 at post-operative week 1 and month 1.

Conclusion

Standalone XEN45 has superior IOP-lowering outcomes compared to XEN45-Phaco in the early post-operative period, up to 6 months after surgery.

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Authors and Affiliations

  1. Department of Ophthalmology, National University Hospital, National University Hospital Systems, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore

    Sheng Yang Lim

  2. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Bjorn Kaijun Betzler

  3. Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore

    Leonard Wei Leon Yip & Bryan Chin Hou Ang

  4. Department of Ophthalmology, Mayo Clinic, Rochester, USA

    Syril Dorairaj

  5. Department of Ophthalmology, Woodlands Health Campus, Singapore, Singapore

    Bryan Chin Hou Ang

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SYL and BKB report no conflicts of interest, financial or propriety, in the subject matter or materials discussed in this manuscript. LWLY is a consultant for Allergan plc and has received previous funding from Allergan for travel and research. However, he has not received funding for his work in this publication. SD is a consultant for New World Medical, Inc, Iridex Corporation and Santen Pharmaceutical Co., Ltd and has received previous funding for travel and research. He has not received funding for his work in this publication. BCHA has received previous funding from Allergan plc for travel and research. However, he has not received funding for his work in this publication.

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Lim, S.Y., Betzler, B.K., Yip, L.W.L. et al. Standalone XEN45 Gel Stent implantation versus combined XEN45-phacoemulsification in the treatment of open angle glaucoma—a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 259, 3209–3219 (2021). https://doi.org/10.1007/s00417-021-05189-x

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