XEN-IMPLANT: MINIMALLY INVASIVE SURGERY FOR THE TREATMENT OF GLAUCOMA

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1 XEN-IMPLANT: MINIMALLY INVASIVE SURGERY FOR THE TREATMENT OF GLAUCOMA SAOO-Kongress Dr. André Mermoud, Glaucoma Center, VISIO-Lausanne, Switzerland

2 The 4 aims of any glaucoma surgery are: The 4 [E] [E] fficient in reducing the IOP [E] asy surgery if possible [E] xclusion of complications [E] ffective for a long time

3 Concept of Minimally Invasive Glaucoma Surgeries «MIGS»

4 Concept of Minimally Invasive Glaucoma Surgeries «MIGS» InnFocus (Arrow) implant XEN-gel tube

5 Concept of Minimally Invasive Glaucoma Surgeries «MIGS»

6 Concept of Minimally Invasive Glaucoma Surgeries «MIGS» CyPass implant

7 All MIGS have in common: increased cost of surgeries Because they all need a surgical device ( chf) MIGS: MIGS: MIGS: Minimally Invasive Glaucoma Surgeries Minimally Effective Glaucoma Surgeries Maximal Income for Glaucoma Syndicate

8 Concept of Minimally Invasive Glaucoma Surgeries «MIGS»

9

10 First implantation : January

11 Lateral movement of the injector may lead to misplacement

12 First post-op day

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14 Montchoisi Study: Eyes / Xen T. 12 Visits ( Before surgery, day 1, day 3, 1 week, 1, 2, 3, 6, 9, 12, 18, 24, 36 months Medical and surgical treatment before: 128/149 (86%) patients were receiving anti-glaucoma therapy 0 med: 21 (14%) 1 med: 30 (20%) 2 meds: 48 (32%) 3 meds: 31 (21%) 4 meds: 19 (13%) Pre-op anti-glaucoma Surgery: 2 DSCI

15 Montchoisi Study: Total number of patients: 149 Age (years): /- 9.9 (49-95) Sex: F 106 (71%), M 43,(29%) Ethnicity: Caucasian: 143 Black: 1 Asian: 3 Hispanic: 2 Diagnostics: POAG: 57 PEXG: 53 PACG: 24 NPG: 2 Others:

16 Montchoisi Study: R/L eye RE: 75 (50.3%) LE: 74 (49.7%) Visual Field: MD: /- 5.9 CLV: /- 2.2 C/D ratio: / Type of surgery: Combined: 109 patients (73%) Glaucoma surgery alone: 40 patients (27%)

17 Mean IOP based on each visits All patients Combined surgeries Glaucoma alone Before Day 1 Day 3 1 Week 1 Month 3 Months 6 Months 12 Months 18 Months 24 Months

18 Mean IOP Combined XEN + XEN only Mean IOP [mmhg] Combined (n=107) XEN (n=41) Preop D1 D3 W1 M1 M3 M6 M12 M18 Follow-up time

19 IOP before IOP after 3 patients with more than Average Value (All values) Before After (all values)

20 IOP before and after in patients with sucess (all IOP < 21 mm Hg) Plot IOP (Only success) 0.0 Average Value (Only success) Before After (only Success)

21 GLAUCOMA TREATMENT BEFORE GLAUCOMA TREATMENT AFTER ALL DATA 4 12% 0 14% 1 12% 2 3% 3 0% 4 0% 3 23% 1 22% 2 29% 0 85%

22 Needlings in combined and in simple glaucoma (39%) in glaucoma surgeries 27 (25%) in combined surgeries

23 Needling and MMC injection with topical and sub-conjunctival anaesthesia

24 Needling and MMC injection with topical anaesthesia

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26 COMPLICATIONS Operative complications: - Hyphema induced by injector mis-manipulation: 5 (3%) - Lost of tube 1 (<1%) Post-operative complications - Hypertony: 3 (2%) - Hypotony: 2 ( both had choroidal detachments (1.3%) - Encysted bleb: 4 (1.6%) - Needling: 17 and 27 (39% and 25%) glaucoma/combined

27 Conclusions Good median-term results Few complications Long-term results?? iphone immaging iphone immaging

28 The 4 aims of any glaucoma surgery are: The 4 [E] [E] fficient [E] asy surgery if possible [E] xclusion of complications YES YES YES [E] fficient for a long time???

29 XEN-Tube and Deep Sclerectomy in ICE- syndrome

30 To reduce the risk of hypotony and later corneal decompensation After Baerveldt tube implantation

31 Take home message: - Is a real MIGS - Offers low post-op pressure - Is followed by minimal complications - First day: good IOP and good vision - Long-term results to be yet studied XEN-gel Implant: - Can be proposed - When medication is not well tolerated - When compliance is poor - In conjunction with phaco in patients with early glaucoma - Should not be used in - In secondary glaucoma - In patients needing very low IOP - If you don t like to do needliongs

32 Thank you for your attention

33 MCQ 1 MIGS stands for A: Minimally Invasive Glaucoma Surgery B: Maximum Income for Glaucoma Surgeons C: Minimally Effective Glaucoma Surgery D: Maximum Income for Glaucoma Industry E: Minimum Time in surgical Theater

34 MCQ 2 XEN-gel Tube A: Can be used in all type of glaucoma B: Can replace trabeculectomy C: Offers the same advantages than deep sclerectomy D: Can replace Baerveldt implant E: Can replace medical therapy of glaucoma

35 MCQ 3 XEN-gel Tube should be used when: A: Patients are not compliant B: Glaucoma is progressing despite maximal medical therapy C: Patient doesn t want a major glaucoma surgery (Trab., DS, Tube) D: first day post-op Vision should not be affected E: You like to do needlings