Cataract and glaucoma combined surgery: XEN? gel stent versus nonpenetrating deep sclerectomy, a pilot study

摘要

BACKGROUND:To compare the efficacy of phacoemulsification (PKE) combined with nonpenetrating deep sclerectomy (NPDS) with mitomycin C (MMC) versus XEN? gel stent with MMC.METHODS:In this nonrandomized, retrospective, comparative, single-center pilot study, 105 consecutive eyes of 75 patients with uncontrolled primary open-angle glaucoma (POAG) and cataract who underwent PKE combined with either XEN implantation (n?=?47) or NPDS (n?=?58) between May 2013 and November 2018 were included. The primary outcome was complete success at 9?months, which was defined as intraocular pressure (IOP) ≤18, 15 or 12?mmHg without treatment; qualified success was IOP ≤18, 15 or 12?mmHg with antiglaucoma medications. Secondary outcome measures included the number of antiglaucoma medications, visual acuity (VA), and postoperative adverse events.RESULTS:Using the 18?mmHg threshold, complete or qualified success was achieved in 69.6 and 89.1% in the PKE?+?XEN group, and 63.8 and 89.7% in the PKE?+?NPDS group (p?=?.54 and p?=?.93), respectively, at 9?months. The mean IOP decreased from 20.8?±?6.8?mmHg to 16.2?±?2.8?mmHg in the PKE?+?XEN group (p??.001, 18.9% mean drop), and from 21.5?±?8.9?mmHg to 14.9?±?3.9?mmHg in the PKE?+?NPDS group (p??.001, 25.6% mean drop). Best-corrected VA significantly improved (p??.001) in both groups. The mean number of antiglaucoma medications was significantly reduced from 2.66?±?1.1 to 0.49?±?1.0 in the PKE?+?XEN group (p??.001) and from 2.93?±?0.9 to 0.69?±?1.2 in the PKE?+?NPDS group (p??.001).CONCLUSIONS:The XEN stent combined with PKE seemed to be as effective and safe as PKE?+?NPDS at 9?months in this pilot study.