A retrospective review of XEN implant surgery: efficacy, safety and the effect of combined cataract surgery.

OBJECTIVES: To investigate the safety and efficacy of glaucoma XEN stent implantation and examine the effect of undergoing combined phacoemulsification and XEN versus XEN implant alone. METHODS: A retrospective case note review of patients who underwent XEN implantation by a single surgeon over a 24-month period was performed. Outcomes included changes in IOP and medication use after XEN implant insertion as well as complications post-surgery. Subgroup analysis was also performed, separating phaco-XEN (phacoemulsification and XEN implantation) and stand-alone XEN implantation. RESULTS: 186 XEN implant procedures were included in this study from a total of 143 patients. Intraocular pressure changes with time were as follows: preoperative 18.1 mmHg (± 5.77), 6 months 13.2 mmHg (SD ± 3.9), 12 months 13.7 mmHg (SD ± 5.6) and 24 months 12.6 mmHg (SD ± 3.1). For visits up to 12 months, comparison from preoperative IOP was significant at the < 0.0001 level; for 18 and 24 months, significance was < 0.05. Medication usage with time was as follows: preoperative 2.5 (SD ± 1.1) 6 months 0.7 (SD ± 0.9), 12 months 0.8 (SD ± 0.97), and 24 months 1.7 (SD ± 1.7). All results were significant at < 0.05 level. Subgroup analysis of separate phaco-XEN and stand-alone XEN groups did not reveal significant differences in IOP; however, there was a significant difference between the two groups preoperatively. Initial hypotony occurred in 75 cases (40%). There were 9 cases of hypotonous maculopathy, 3 cases of persistent choroidal effusions, 3 cases of IOP spikes, 1 cases of cyclodialysis cleft and 1 case of corneal decompensation. 25 (13%) cases had needling during their treatment. CONCLUSION: The XEN implant appears to be safe and effective at reducing intraocular pressure and medication usage in glaucoma patients. XEN implantation is an effective treatment option for a range of glaucoma types and can be used as a stand-alone procedure or combined with cataract surgery to treat glaucoma patients.

XEN-related hypotonous maculopathy from iatrogenic cyclodialysis cleft treated with argon laser gonio-cyclopexy.

We present a previously undescribed case of a persistent hypotony maculopathy secondary to an iatrogenic cyclodialysis cleft created during XEN-45 gel stent insertion. We present this case as a further analysis of the Karimi et al case of cyclopexy by the corresponding surgeon. Following right XEN-45 implantation, our patient developed immediate and persistent postoperative hypotony for 4 weeks. Gonioscopy revealed a small cyclodialysis cleft at the 1-2 o'clock position. The cyclodialysis cleft was sealed with direct gonioscopic argon laser cyclopexy. Two months after laser treatment and total of 6 months post XEN-45 insertion, right eye visual acuity returned to 6/4 with intraocular pressure 11 mm Hg without any glaucoma medication. Here, we present details of the non-invasive safe and successful management of hypotony maculopathy secondary to the cleft using Argon laser gonio cyclopexy, with no requirement of return to theatre.

Variations in Treatment Delivery for Patients with Neovascular AMD in the UK: Results from an Ophthalmology Trainee Clinical Research Network Study.

INTRODUCTION: The aim of this study was to determine treatment delivery patterns for patients with neovascular age-related macular degeneration (nAMD) across the UK through an ophthalmology trainee research network delivered observational study. METHODS: Data were collected via an online tool by potential research collaborators identified by the Ophthalmology Trainee Clinical Trial Network (OCTN). Collaborators were asked to comment on periprocedural practices of treatment of nAMD in their eye unit including treatment location and injectors, clinical assessment and routine observation in patients undergoing intravitreal treatment. RESULTS: Data were available from 26 units around the United Kingdom. Survey methodology refinement was approximately 3 months, and the average response time was 4.9 ± 2.4 days. The majority of responders confirmed that treatment was undertaken as a "one-stop" service (n = 15, 58%), delivered in a clean room (n = 23, 88%). In the majority of units, doctors administered injections (n = 24, 92%), but significant treatment was also given by nurse injectors (n = 21, 81%). All collaborators reported that patients underwent visual acuity testing and optical coherence tomography imaging at all visits, but other imaging including fundus fluorescein angiography (FFA) did not take place in all cases (n = 17, 65%) and only at baseline visit. CONCLUSIONS: These results demonstrate the feasibility of conducting ophthalmology trainee led and delivered observational studies. Our results show that FFA is not routinely used in the diagnosis of nAMD in the units sampled; most injections are carried out in a clean room, and ophthalmic nurses delivering injections is a highly prevalent model of care in the UK.