Xen Gel Stent Implantation with Deep Sclerectomy in the Management of Neovascular Glaucoma

Author(s): Cenk ZEKI FIKRET

Background: To evaluate the efficacy and safety profile of Xen gel stent implantation combined with deep sclerectomy in eyes with neovascular glaucoma.

Methods: Twenty five patients with neovascular glaucoma due to central retinal vein occlusion were included in our study. Panretinal photocoagulation treatment was completed within a break period of two weeks. Intravitreal 0.05 ml bevacizumab was injected seven days before surgery. Despite iris and angle neovascularization regression, full antiglaucomatous treatment to patients whose intraocular pressures (IOP) were 21mm Hg and above were operated. Xen gel stent implantation with deep sclerectomy was performed to all patients. Complete success was defined as IOP ≤18 mm Hg and ≥20% IOP reduction without antiglaucomatous medication and another IOP lowering procedure. Partial success was defined as IOP ≤18 mm Hg and ≥20% IOP reduction with antiglaucomatous medi-cation or needling. Surgical failure was considered in eyes requiring a secondary antiglaucomatous surgery.

Results: The mean preoperative IOP was 35.88±8.24 mm Hg under medication, which was reduced to 14.92±1.68 mm Hg at the 1st year visit (p<0.001). Complete success occurred in 15 (60%) patients and partial success occurred in 9 (36%) patients after surgery. Ahmed glaucoma valve implantation was performed in one patient at the end of the first month due to surgical failure (4%).

Conclusion: Xen gel stent implantation with deep sclerectomy is demonstrated to be an effective treatment with a good safety profile in neovascular glaucoma patients at the 1 year follow-up period.