The feasibility and efficacy of implanting a XEN45 gel stent via an open conjunctiva ab externo technique were evaluated. At 12 months of follow-up, both intraocular pressure (IOP) and the number of glaucoma drugs were significantly reduced. This research aims to evaluate the feasibility and performance of implanting XEN45 stents through an ab externo (outside the eye) incision in the conjunctiva. Chart reviews of all patients who received a XEN45 implant between July 2018 and March 2020. The number of glaucoma drugs and intraocular pressure (IOP) was measured preoperatively and at 1, 3, 6, and 12 months postoperatively. Success rates at 12 months after surgery are the primary focus of this analysis. A total of 44 patients’ eyes were examined. With a mean IOP of 26.±28.7 mm Hg before surgery, patients used a combination of 3.2±0.7 IOP-reducing medicines. Following 12 months of eye treatment, the average intraocular pressure was 18.±99.1 mm Hg (n=35, P<0.0001; mean reduction of 27.9%) with 0.9±1.4 (n=35, P<0.0001) IOP-lowering medicines. In 5 (11.4%) patients, needling was performed after surgery. About 14 patients (40.0%) out of the 35 with a 12-month follow-up had a 100% success rate, whereas 3 (8.6%) had a 50% success rate. At 12 months, there were 18 failures (51.4%); 4 patients needed additional glaucoma surgery (2 XEN45 implants, 1 trabeculectomy, and 1 Baerveldt implant), and 14 patients did not achieve the desired decrease in intraocular pressure (IOP). In addition, there was 1 case of self-limited hypotony, 2 cases of self-resolving choroidal effusions, and 3 cases of bleb leaking in the postoperative period. Success in lowering intraocular pressure (IOP) was seen in 48.6% of glaucoma cases within the 1st year following XEN45 implantation using an open conjunctiva ab externo technique. Additional glaucoma surgery (not including needling operations), transitory hypotony, and bleb leak were the most prevalent complications.