Treatment results of standalone XEN-45 implantation in patients with primary and secondary open-angle glaucoma

PURPOSE: The purpose of this study was to evaluate the treatment results and complications of XEN-45 microstent implantation in open-angle glaucoma.
METHODS: In this study, 17 eyes of 17 patients who underwent XEN-45 implantation with 0.2 mg/cc mitomycin-c between June 2016 and February 2018 were retrospectively examined. Pre- and post-operative best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of antiglaucomatous drugs, endothelial cell count (ECC), retinal nerve fiber layer (RNFL) thickness, number of post-operative needlings, and post-operative complications were evaluated.
RESULTS: The mean age of the patients (11 M, 6 F) was 62.6±19.8 (29–94) years and mean follow-up period was 16.8±3.5 (12–21) months. The mean IOP which was 27.6±6.0 (21–40) mmHg before glaucoma surgery decreased significantly to 14.1±3.3 3.4 (8–20) mmHg at the last visit (p<0.001). The number of antiglaucomatous drugs was 3.9±0.8 (2–5) preopera-tively and 1.7±1.3 (0–3) at the final examination (p=0.001). Pre-operative BCVA was 0.78±0.99 LogMAR and 0.8±0.99 LogMAR at the last visit (Wilcoxon test, p=0.99). The ECC was 2356.8±533.3 (1635–3275) cells/mm2 preoperatively and 2338.7±472.7 (1712–3178) cells/mm2 at the last visit and did not show statistically significant difference (p=0.470). The pre- and post-op-erative RNFL thickness measurements were 61.4±11.8 (43–82) μm and 61.3±11.5 (45–82) μm at the last visit, respectively (p=0.764). Needling was required in 4 (23.5%) eyes. Post-operative complications were observed in four eyes (23.5%). In the early post-operative period (≤1 month), shallow anterior chamber and hypotony were detected in 1 eye and were treated medically. As late complications (>1 month), Tenon’s cyst in two eyes and fibrotic bleb in one eye were observed.
CONCLUSION: XEN-45 implant surgery in open-angle glaucoma patients is an effective surgical procedure for IOP control. With preserved visual acuity and ECC, causing no devastating complications, it can also be considered as a very safe option in open-angle glaucoma cases.