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Prospective Evaluation of XEN Gel Implant in Eyes With Pseudoexfoliative Glaucoma

Mansouri, Kaweh, MD, MPH*,†; Gillmann, Kevin, MBBS, FEBOphth. MArch*; Rao, Harsha L., MD, PhD; Guidotti, Jacopo, MD*; Mermoud, André, MD*

doi: 10.1097/IJG.0000000000001045
Original Studies

Purpose: The main purpose of this study was to compare the safety and efficacy of XEN gel implant surgery in patients with pseudoexfoliative glaucoma (PEXG) and primary open-angle glaucoma (POAG).

Setting: This was a prospective, interventional study in a tertiary glaucoma center.

Methods: Fifty-seven eyes (43 patients) with POAG and 53 eyes (42 patients) with PEXG with uncontrolled intraocular pressure (IOP) despite medical treatment underwent combined XEN+cataract surgery or standalone XEN surgery. Mean IOP, mean number of medications at 1-year follow-up, needling rates, and incidence of adverse effects (AEs) were analyzed. Complete success, defined as an IOP <16 mm Hg without medications at 1 year, was also analyzed.

Results: Combined XEN+cataract surgery was performed in 72% of POAG and 75% of PEXG eyes (P=0.674), the remainder underwent standalone XEN surgery. Patient characteristics were similar between the 2 groups except for higher age for the PEXG patients (78.5±8.5 vs. 71.3± 8.7 y; P<0.001). Mean medicated IOP was 19.8±5.8 (POAG) and 19.7±8.2 (PEXG) at baseline (P=0.98) and 13.9±4.6 (−29.8%) and 13.6±4.3 mm Hg (−31%) at 1 year (P=0.87), respectively (P<0.01). Mean medications dropped from 1.9±1.6 (POAG) and 2.0±1.3 (PEXG) preoperatively to 0.4±0.8 and 0.5±0.8, respectively at 1 year (P<0.001). A total of 42% (POAG) and 63% (PEXG) eyes achieved complete success (P=0.06) at 1 year. Needling was performed in 36.8% (POAG) versus 37.7% (PEXG) (P=0.923).

Conclusions: The XEN gel implant as a standalone or combined procedure demonstrated similar efficacy and safety results in PEXG and POAG eyes.

*Glaucoma Research Center, Montchoisi Clinic, Swiss Vision Network, Lausanne, Switzerland

Department of Ophthalmology, University of Colorado School of Medicine, Denver, CO

Narayana Nethralaya, Hulimavu, Bengaluru, Karnataka, India

Supported in part by the Swiss Glaucoma Research Foundation, Lausanne, Switzerland. K.M. and A.M. had previously received speaking honoraria and research support from Allergan Inc.

Disclosure: The authors declare no conflict of interest.

Reprints: Kaweh Mansouri, MD, MPH, Glaucoma Research Center, Montchoisi Clinic, Swiss Vision Network, Chemin des Allinges 16, 1006 Lausanne, Switzerland (e-mail:

Received June 12, 2018

Accepted July 28, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.