From the Guidelines
Trabeculectomy is generally the preferred procedure for managing glaucoma due to its ability to achieve greater pressure reduction and potentially more durable long-term results, as evidenced by the Tube Versus Trabeculectomy (TVT) Study 1. When considering the choice between XEN gel stent implantation and trabeculectomy, several factors come into play, including the severity of glaucoma, previous eye surgeries, medication tolerance, and lifestyle needs.
- Key differences between the two procedures include their invasiveness, recovery time, and complication profiles, with XEN being less invasive and having a quicker recovery but potentially fewer complications like hypotony or bleb-related issues 1.
- The TVT Study, a multicenter prospective randomized clinical trial, compared the safety and efficacy of tube-shunt surgery using the 350-mm2 Baerveldt glaucoma implant and trabeculectomy with MMC in patients with previous cataract extraction and/or failed trabeculectomy, finding that tube-shunt surgery had a higher success rate than trabeculectomy during 5 years of follow-up, but both surgical procedures were associated with similar IOP reduction, use of supplemental medical therapy, serious complications, and vision loss at 5 years 1.
- However, other studies have shown that trabeculectomy can achieve greater pressure reduction and may be more durable long-term, making it a preferable option for advanced or refractory cases 1.
- Ultimately, the decision between XEN gel stent implantation and trabeculectomy should be made in consultation with an ophthalmologist who can assess the specific eye condition, glaucoma severity, and other relevant factors to determine the best course of treatment 1.
From the Research
Comparison of XEN Implantation and Trabeculectomy
- The decision to undergo XEN implantation or Trabeculectomy should be evaluated on a case-by-case basis, considering the high rate of needling of the XEN45 implant 2.
- Trabeculectomy surgery reduces intraocular pressure (IOP) more than the XEN45 implant over 3 years, with no difference in the number of antiglaucoma medications between the two procedures 2.
- The needling rate was 19% in XEN45 versus 5.6% in the Trabeculectomy group, with Trabeculectomy having a significantly lower need for additional needling surgery 2.
Surgical Techniques and Outcomes
- The XEN45 Glaucoma Treatment System is a minimally invasive bleb-forming surgical device that can be performed ab interno or ab externo with open or closed conjunctiva, based on patients' needs and/or surgeons' preferences 3.
- Trabeculectomy might be a safer and better way to treat patients with neovascular glaucoma, with similar surgical success, intraocular-pressure reductions, visual acuity, and number of medications at the last visit 4.
- Glaucoma drainage implants, such as the XEN45, may have similar efficacy and safety profile compared to Trabeculectomy with antimetabolites, and could be considered as an initial surgical option 5.
Post-Surgical Outcomes and Complications
- Trabeculectomy is a viable surgical option to treat IOP that is uncontrolled after glaucoma drainage device implantation, with a cumulative success rate of 73.2% and 68.2% for certain IOP targets 6.
- Hypotony maculopathy was a serious complication that needed surgical revision in 10% of patients who underwent Trabeculectomy after glaucoma drainage device implantation 6.
- The XEN45 implant had a higher needling rate and more complications, such as anterior chamber flattening and hyphema, compared to Trabeculectomy 2.