Comparative Efficacy and Safety of XEN®45 Gel Stent versus Preserflo™ in Glaucoma: A Systematic Review and...

Glaucoma is a leading cause of irreversible blindness. Lowering intraocular pressure (IOP) is the only proven way to slow progression. XEN®45 and PRESERFLO™ are minimally invasive bleb-forming devices used in glaucoma surgery. Their comparative performance remains debated.

We performed a systematic review and meta-analysis according to PRISMA guidelines. PubMed, Scopus, and Web of Science were searched through November 2025. Studies directly comparing XEN®45 and PRESERFLO™ were included. The primary outcomes were postoperative IOP and surgical success (Criteria A: IOP < 21 mmHg with ≥20% reduction and no repeat surgery). Secondary outcomes included number of glaucoma medications and postoperative revisions. Random-effects models were used.

Six studies including 840 eyes were analyzed. XEN®45 was associated with higher postoperative IOP compared with PRESERFLO™ (MD = 1.63 mmHg, p < .0001, I² = 0.0%). XEN®45 also showed lower surgical success (RR = 0.72, p < .0001, I² ≈ 0%). No significant difference was found in medication reduction or revision rates in the primary analysis. Sensitivity analyses confirmed the robustness of the main findings.

Both devices are effective. However, PRESERFLO™ achieved lower IOP and higher surgical success under strict criteria. The differences were small but consistent. PRESERFLO™ may offer a modest advantage in patients requiring low target IOP.