XEN‑45 implantation for refractory secondary glaucoma

To evaluate the efficacy and safety of XEN-45 gel stent in different types of refractory secondary glaucoma (SG). This retrospective analysis included 39 patients (42 eyes) who underwent XEN-45 gel stent implantation for medically uncontrolled SG using two approaches, ab externo closed-conjunctiva (AEC) and ab externo open-conjunctiva (AEO). The intraocular pressure (IOP) and numbers of antiglaucoma medications were compared between preoperative and postoperative values. The requirement for revision, bleb needling and further glaucoma surgery were recorded. IOP was decreased significantly from 31.79 ± 10.62 mmHg to 14.06 ± 4.45 mmHg (p < 0.001) by the final visit (averaging 13.74 ± 7.96 months post-surgery) and the number of antiglaucoma medications was reduced from 3.67 ± 0.87 to 0.36 ± 0.82 (p < 0.001). Twenty-three eyes (54.8%) required postoperative needling. Twelve eyes (28.6%) required open conjunctival bleb revision. At the final follow-up, 33 eyes (78.6%) achieved complete success, defined as an IOP of 18 mmHg or lower without medications, and 36 eyes (85.7%) reached qualified success, maintaining an IOP of 18 mmHg or lower with medications, while 2 eyes (4.76%) needed trabeculectomy. There were no vision-threatening and ocular infection complications intraoperatively or postoperatively. XEN-45 gel stent provides a minimally invasive option for eyes with SG and requires close monitoring and timely postoperative management. The incidence of adverse events following the procedure is rare.