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EW GLAUCOMA 50 March 2019 by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer for achieving success and in the number of complications were not statistically significant (p=.208 and .209, respectively). Limitations According to Dr. Moura–Coelho, the study's limitations include: the small sample size, univariate analy- sis, and the non–randomized, single center, retrospective study design. "The absolute number of successful cases was higher in PG eyes and eyes requiring additional surgeries were lower in this group as well compared to eyes with SG. Larger, prospective studies would be needed to confirm our results that the etiology of glaucoma plays a role in XEN surgery outcomes and to as- certain whether secondary glaucoma might be associated with surgical complications," Dr. Moura–Coelho said. EW References 1.Moura–Coelho N, et al. XEN 45 gel stent implant: comparison of 1–year results in pri- mary open–angle glaucoma versus secondary open–angle glaucoma. Abstract presented at the 36th Congress of the European Society of Cataract and Refractive Surgeons. 2018. 2. Argo C, Havens S. A review of the data on the recently approved XEN surgical gel stent in the management of glaucoma. JOJ Ophthalmol. 2017; 3(4). 3. Chen DZ, Sng CCA. Safety and efficacy of microinvasive glaucoma surgery. J Ophthal- mol. 2017;2017:3182935. Editors' note: Dr. Moura–Coelho has no financial interests related to his comments. Contact information Moura–Coelho: nunomouracoelho.oft@gmail.com follow–up exam, which was defined as an IOP reduction rate (IOP–RR) of greater than or equal to 20% from baseline and an IOP of less than or equal to 18 mm Hg and above 5 mm Hg, with the need for IOP–lowering drugs (qualified success) or with- out the need for drugs (complete success), and without reoperation for glaucoma including needling. The secondary outcome measures included IOP reduction, IOP–RR, re- duction in the number of IOP–low- ering drugs, and complications. At 12 months post–XEN implantation, Dr. Moura–Coelho observed a significant IOP reduc- tion in the PG group (10 mm Hg, p=.006), as well as a lower median number of drugs (–3, p=.003). The difference was not significant in the SG group (–2 mm Hg, p=.069). Median IOP reduction and IOP–RR were significantly higher in the PG group compared with the SG group (p=.039 and .039, respectively). Dr. Moura–Coelho noted that the dif- ferences between the patient groups has demonstrated its effect on IOP lowering and medication reduction in open angle glaucoma patients, with a good safety profile, in a num- ber of publications. 2,3 Study design and outcomes Dr. Moura–Coelho's study compared the safety and efficacy 1 year after implantation of the XEN 45 Gel Stent between eyes with medically refractory primary open angle glau- coma (POAG) and secondary open angle glaucoma (SOAG). The study was conducted at the ophthalmol- ogy department of Central Lisbon Hospital Center and reports the initial experience with XEN implan- tation nationwide. The retrospective interventional case series included 19 eyes of 18 patients with mrOAG who under- went XEN implantation. The pa- tients were grouped into two groups according to glaucoma etiology: POAG/PG and SOAG/SG. The primary outcome mea- sure was success at the 12–month Superior performance was observed with the XEN 45 Gel Stent in primary open angle glaucoma eyes over a 12-month period, according to new study data T he results of a new 12– month study 1 seem to indicate that the etiology of glaucoma may influence the outcomes of XEN 45 Gel Stent (Allergan, Dublin, Ireland) implantation surgery in glaucoma patients. Individuals with primary open angle glaucoma showed a higher benefit 1 year after surgery than those with secondary open angle glaucoma, according to Nuno Moura–Coelho, MD, ophthalmol- ogy department, Central Lisbon Hospital Center, faculty of medical sciences, NOVA Medical School, Lis- bon, Portugal, who presented the as yet unpublished study data in a talk he held on behalf of his study group at the 36th Congress of the Europe- an Society of Cataract and Refractive Surgeons (ESCRS). "Although it is well known that the XEN stent reduces IOP and the need for pressure-reducing medica- tions in open angle glaucoma, it is still unknown whether the type of open angle glaucoma influences or is a determinant of the long–term outcomes of XEN stent implanta- tion. In our study, the XEN stent appears to have higher efficacy in IOP reduction in primary open angle glaucoma patients when compared with secondary open angle glauco- ma patients," Dr. Moura–Coelho said in his presentation. The XEN 45 microinvasive surgical device is an FDA–approved implant for medically refractory open angle glaucoma (mrOAG). It Presentation spotlight XEN 45 Gel Stent compared in primary and secondary angle closure eyes " Larger, prospective studies would be needed to confirm our results that the etiology of glaucoma plays a role in XEN surgery outcomes and to ascertain whether secondary glaucoma might be associated with surgical complications. " —Nuno Moura-Coelho, MD Members.ASCRS.org/core/user/login.aspx

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