5-Year Surgical Success and Outcomes of XEN-45 Microstent Combined with Cataract Surgery

To evaluate long-term intraocular pressure (IOP), number of antiglaucoma medications (AGMs), and success after phacoemulsification combined with XEN-45 implantation (Phaco+XEN-45), and to compare these outcomes between primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG).

This retrospective study included 30 patients (30 eyes; 17 POAG, 13 PEXG) who underwent Phaco+XEN-45 implantation. IOP, number of AGMs, postoperative interventions, complete or qualified surgical success (IOP of 5-18 mmHg with AGMs or independent of AGMs, respectively), and failure (failure to achieve qualified success) were evaluated at 1, 2, 3, 4, 5 years postoperatively and at the final follow-up.

The median IOP at baseline was 20.5 (14.8-26.5) mmHg and decreased to 16.0 (14.8-17.3) mmHg at 5 years. The median number of AGMs decreased from 3.0 (2.0-3.3) at baseline to 2.0 (0.0-2.3) at 5-year, presenting a significant reduction at all follow-up time points (p < .001). The median IOP did not differ between POAG and PEXG during follow-up, whereas PEXG required more AGMs at 1 and 2 years (p = .048 and p = .031, respectively). Kaplan-Meier analysis showed complete success rates of 60% and 36% and qualified success rates of 100% and 96%, at 1 and 5 years, respectively; with 70% qualified success rate at 8 years. Long-term success did not differ between the POAG and PEXG groups.

Phaco+XEN-45 implantation offers a significant reduction in AGMs and a marked decrease in IOP, with an acceptable long-term efficacy and safety profile. The similarity in the success rates of POAG and PEXG suggests that Phaco+XEN-45 is a feasible and safe option for both types of glaucoma with appropriate patient selection and effective postoperative bleb modulation.