Influence of Mitomycin C on the Therapeutic Success of Stand-Alone Xen45 Gel Stents and Its Combination with Cataract Surgery in Open-Angle Glaucoma Patients

Abstract

Purpose Minimally invasive glaucoma surgery (MIGS), like Xen45 gel stents, is known as effective therapy in lowering intraocular pressure (IOP); however, fibrotic reactions are a common problem in postoperative management. It was the aim of this study to investigate the therapeutic success of Xen45 gel stents as a stand-alone technique (Xen) and combined with cataract surgery (XenPhaco), and with antimetabolites (mitomycin C, MMC) in open-angle glaucoma patients.

Methods Retrospective analysis was performed of 199 eyes of 177 glaucoma patients of the Department of Ophthalmology, University of Erlangen Nürnberg, and from the Erlangen Glaucoma Registry (NCT00494923; ISSN 2191-5008, CS-2011) who underwent implantation of a Xen45 gel stent. Therapeutic success was defined as IOP reduction of ≥ 20% on the same or less anti-glaucomatous medication after 12 months compared to preoperative and without any additional glaucoma-related surgery (except bleb needling). IOP reduction, reduction in local anti-glaucomatous eye drops, and intra- and postoperative complications were monitored.

Results Stand-alone Xen45 gel stent: therapeutic success was reached in 39% (–MMC) and 55% (+MMC). Failure rate was 61% (–MMC) and 45% (+MMC). XenPhaco: therapeutic success was achieved in 57% (–MMC) and 46% (+MMC). Failure rate was 43% (-MMC) and 54% (+MMC). Data were not different for group and subgroup analyses (p > 0.05).

Conclusions The use of MMC seemed to increase the therapeutic success rate after stand-alone Xen45 gel stent implantation and combined with cataract surgery, yet statistical significant was not reached.

Zusammenfassung

Hintergrund Minimalinvasive Glaukomchirurgie (MIGS), wie z. B. der Xen45-Gel-Stent, gelten als eine effektive Therapie, um den intraokulären Druck (IOD) zu senken. Jedoch führt die postoperative Fibrosierung häufig zu IOD-Anstiegen mit dem konsekutiven Bedarf an Needlings. Das Ziel dieser Studie war es, den therapeutischen Erfolg des Xen45-Gel-Stents zu untersuchen, hinsichtlich des Nutzen einer intraoperativen Anwendung von Antimetaboliten (Mitomycin, MMC) bei Patienten mit Offenwinkelglaukom. Zudem wurde ein Augenmerk auf einen potenziellen Einfluss einer Stand-alone-Implantation der Xen45-Gel-Stents sowie einer Kombination mit Kataraktoperation gelegt.

Methode Hierfür erfolgte eine retrospektive Analyse von 199 Augen von insgesamt 177 Patienten der Abteilung für Augenheilkunde der Universität Erlangen-Nürnberg sowie des Erlanger Glaukom Registers (NCT00494923; ISSN 2191-5008, CS-2011).

Ergebnisse Der therapeutische Erfolg wurde definiert als IOP-Reduktion von ≥ 20% nach 12 Monaten mit ≤ antiglaukomatöser Lokaltherapie im Vergleich zu präoperativ und ohne zusätzliche glaukomspezifische Operation (Needling ausgenommen). Verglichen wurden hierbei der Effekt auf den IOD, die Reduktion der Anzahl an lokaler antiglaukomatöser Therapie sowie intra- und postoperative Komplikationen.

Resultate Xen45-Gel-Stent: Ein therapeutischer Erfolg lag in 39% (–MMC) und in 55% (+MMC) vor. XenPhaco: Ein therapeutischer Erfolg konnte in 57% (–MMC) und 46% (+MMC) erzielt werden. Es zeigte sich kein Unterschied bezüglich des Therapieerfolgs zwischen den Glaukomtypen sowie der Operationsprozedur (p > 0,05).

Schlussfolgerung MMC scheint die Erfolgsraten sowohl für die Stand-alone-Implantation des Xen45-Gel-Stents als auch für die Implantation des Xen45-Gel-Stents in Kombination mit einer Kataraktoperation zu erhöhen, wenn auch nicht statistisch signifikant.

Key words

MIGS - Xen Stent - glaucoma - IOP - MMC - fibrosis

Schlüsselwörter

MIGS - Xen-Stent - Glaukom - IOP - MMC - Fibrose

Publication History

Received: 30 November 2020

Accepted: 29 January 2021

Article published online:
17 May 2021

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