Surgical Outcome Comparison of Open Conjunctival Ab Externo Xen 45 Gel Stent Implantation vs Trabeculectomy in...

To evaluate the safety, efficacy, and risk factors for failure compared between trabeculectomy and open conjunctival ab externo Xen 45 gel stent (XGS AEO) placement.

For this retrospective single-center study, we included eyes of patients >18 years old with open-angle glaucoma and baseline intraocular pressure (IOP) >17 mm Hg who received trabeculectomy or XGS AEO placement. We excluded aphakic eyes and those missing preoperative data. The primary outcome was the rate of success (6 ≤ IOP ≤ 21 mm Hg, plus ≥20% IOP reduction from baseline, with or without ocular hypotensive medications) after 1 year, compared between groups. Alternative IOP upper limits were 18 and 15 mm Hg. Secondary outcomes were risk factors for failure, complications, and postoperative interventions.

We studied 82 trabeculectomy eyes and 34 XGS AEO eyes. At 1 year, 62%, 61%, and 49% of trabeculectomy eyes and 72%, 69%, and 31% of XGS AEO eyes achieved success using IOP upper limits of 21, 18, and 15 mm Hg, respectively. There were no 1-year intergroup differences in IOP, IOP percent change, visual acuity, complications, or revision surgeries. Medication use was higher in the XGS AEO group. Prior trabeculoplasty was associated with a lower risk for failure in the XGS AEO group, but an increased risk in the trabeculectomy group. More eyes in the trabeculectomy group underwent manipulations postoperatively (p = 0.020).

Open conjunctival ab externo Xen placement is similar in efficacy and safety to trabeculectomy.

The similar outcomes and fewer postoperative manipulations of XGS AEO implantation compared to trabeculectomy make it a reasonable surgical option in open-angle glaucoma.

Applebaum SS, Hundito A, Teng CC, et al. Surgical Outcome Comparison of Open Conjunctival Ab Externo Xen 45 Gel Stent Implantation vs Trabeculectomy in Open-angle Glaucoma. J Curr Glaucoma Pract 2025;19(4):158-167.