The following is the summary of “One-Year Outcomes of Standalone XEN Gel Stent Versus Non Penetrating Deep Sclerectomy” published in the December 2022 issue of Glaucoma by Touboul, et al.
The surgical success rate for non penetrating deep sclerectomy (NPDS) was much higher than that of XEN gel stent placement alone, yet the 2 procedures shared an identical safety profile. The goal of this research was to evaluate the relative surgical efficacy and safety of NPDS and XEN gel stents. Between January 2017 and December 2018, medical records for 282 patients at Groupe Hospitalier Paris Saint-Joseph were reviewed retrospectively. These patients were scheduled to have either NPDS (n=188) or XEN gel stent surgery (n=140). The primary outcome measure was the percentage of patients who were successfully treated by the operation 12 months following the procedure. Intraocular pressure (IOP) ≤18 mm Hg and IOP reduction of 20% without or with hypotensive medication were used as the criteria for successful surgical outcomes.
The total number of eyeballs in the XEN group was 82, while the NPDS group had 124. At the end of the follow-up period, the “full success” and “qualified success” rates in the XEN group were 28.57 and 20.00%, while they were 42.72 and 16.50% in the NPDS group (P=0.17) in the 1-eye analysis. A Kaplan-Meier estimation of long-term surgical success showed a median success probability time of 3.73 years in the NPDS group and 2.38 years in the XEN group (P<0.0001). Using Cox regression, we observed that the NPDS technique was substantially linked with surgical success compared to the implantation of XEN gel stents (P<0.001).
No significant difference was shown in terms of decreasing the use of antiglaucoma drugs, needling treatments, or subsequent surgical procedures. Patients with open-angle glaucoma may have greater success with the NPDS surgery than with the XEN gel stent in terms of lowering their intraocular pressure (IOP). However, these findings need to be confirmed by a well-executed prospective randomized trial.