Early Postoperative Intraocular Pressure is Associated With Better Pressure Control After XEN Implantation. Issue 6 (June 2020)

• Record Type: Journal Article
• Authors: Cutolo, Carlo A.; Iester, Michele; Bagnis, Alessandro; Bonzano, Chiara; Negri, Letizia; Olivari, Sara; Cappelli, Francesca; Testa, Valeria; Sindaco, Daniele; Pizzorno, Chiara; Scotto, Riccardo; Saccheggiani, Michela; Traverso, Carlo E.
• Is Part Of: Journal of glaucoma. Volume 29:Issue 6(2020)
• Publication Date: 2020-06
• Subjects: glaucoma -- surgery -- XEN implant -- prognostic factors; Glaucoma -- Periodicals; 617.741005
• DOI: 10.1097/IJG.0000000000001501
• Languages: English
• ISSNs: 1057-0829

Abstract

Abstract : Précis: Gel stent implantation is a bleb-forming surgery designed to achieve predictable pressure drop. An early low intraocular pressure (IOP) is associated with the long-term success of the procedure. Purpose: To identify the variables associated with the success of the XEN procedure. Patients and Methods: This was part of a prospective, uncontrolled, consecutive case series study. Patients with primary open-angle glaucoma or pseudo-exfoliative glaucoma were included. All the patients underwent surgical XEN implant procedure with mitomycin-C subconjunctival injection 20 minutes before surgery. Success criteria were an off-medication IOP of 6 to 16 mm Hg 12 months after surgery; no additional glaucoma surgery; no visual threatening complications, no visual acuity loss >1 Snellen line. One eye per patient was considered for statistical analysis. A univariate Cox proportional hazard regression analysis was performed to identify potential risk factors for surgical failure. Then, a multivariate Cox model was built. Results: One hundred twenty-three patients were recruited in this study: 93 patients underwent XEN implantation alone whereas 30 the combined procedure with phacoemulsification and intraocular lens implantation. Univariate Cox regression showed that the day after surgery intraocular lens>9 mm Hg was associated with surgical failure ( P =0.02) and a postoperative number of needlings ≥2 in the follow-up was also predictive of surgical failure ( P <0.01). These data were confirmed by a multivariate model too. At 1 year the surgical success criteria were 76% in the group with 24-hour IOP⩽9 mm Hg, whereas it was 43% when above 9 mm Hg ( P =0.026). Conclusions: Our study shows that an early IOP⩽9 mm Hg is predictive of the efficacy of the procedure during 1-year follow-up, whereas more than 2 needlings are predictive of failure.