XEN implant device versus trabeculectomy, either alone or in combination with phacoemulsification, in open-angle glaucoma patients

PurposeTo compare the efficacy and safety of the XEN45 implant with that of trabeculectomy (TRAB), either alone or in combination with phacoemulsification (PHACO), in patients with open-angle glaucoma (OAG).MethodsRetrospective, single-center and comparative study conducted on OAG patients. Patients were divided into four groups: group 1 (XEN alone); group 2 (XEN+PHACO); group 3 (TRAB alone); group 4 (TRAB+PHACO). For statistical purposes, groups 1 and 2 were combined (XEN implant), while groups 3 and 4 were also combined (TRAB surgery). The main outcome measure was intraocular pressure (IOP).ResultsNinety-one patients (121 eyes; 65 XEN and 56 TRAB) were included. IOP reduction was -6.7 (-10.4 to -3.0)mmHg, p=0.0013; -3.5 (-5.0 to -2.0)mmHg, p<0.0001; -8.1 (-10.4 to -5.9)mmHg, p<0.0001l; and -7.3 (-9.3 to -5.3)mmHg, p<0.0001 in the XEN alone, XEN+PHACO, TRAB alone, and TRAB+PHACO, respectively. At month 12, an IOP >= 6 and <= 16mm without treatment was achieved by 44 (67.7%) and 43 (76.8%), p=0.2687 in the XEN implant and the TRAB surgery groups, respectively. The mean number of antiglaucoma medications was significantly reduced in all the study groups (p<0.0001 each). Needling occurred in 20.0% (13/65) of eyes in the XEN implant group, while hyphema occurred in 30.4% (17/56) of eyes in the TRAB group.ConclusionsXEN implant, either alone or in combination with phacoemulsification, significantly reduces both IOP and the number of antiglaucoma medications to a similar rate than trabeculectomy, but with a better safety profile.