XEN gel stent ® in the management of glaucoma: preliminary results of a tertiary center


  • Rita Vieira Centro Hospitalar Universitário do Porto (CHUP)
  • Ana Figueiredo Centro Hospitalar Universitário do Porto (CHUP)
  • Isabel Sampaio Centro Hospitalar Universitário do Porto (CHUP)
  • Maria João Menéres Centro Hospitalar Universitário do Porto (CHUP)




XEN ® gel stent, XEN45 ® gel stent, glaucoma


Purpose: To analyze the efficacy and safety of a MIGS device (XEN gel stent ®) in the management of glaucoma in our tertiary center. 

Methods: Retrospective analysis of patients submitted to XEN ® implant alone or combined with cataract surgery. Patients with previous filtering surgeries were included. Intraocular pressure (IOP) was evaluated at 1st week, 1st, 3rd, 6th and 12th months after surgery. BCVA, RNFL thickness and number of antiglaucoma medications were evaluated 1 year after surgery. Early and late complications and need for an additional glaucoma surgery were recorded.

Results: Thirty-four eyes from 28 patients were included. The main diagnosis was primary open angle glaucoma (POAG) (58.8%).

IOP decreased from 20.5±4.9 mmHg to 15.4±4.1 mmHg 1 year after surgery (p<0.001). There was also a decrease in the number of antiglaucoma medications, from 3.6±0.6 to 0.6±0.7 (p<0.001). BCVA increased from 0.57±0.30 to 0.87±0.18 in the combined surgery group (p=0.03). RNFL thickness remained stable (p=0.558).

Hypotony occurred in 2 eyes (5.9%). Two eyes (5.9%) needed another glaucoma surgery in the 1st year of follow-up.

Conclusion: According to our results, XEN® alone or combined with phacoemulsification showed to be effective in IOP reduction, with few complications, as a primary surgery or even in eyes with previous filtering surgeries.

Author Biographies

Rita Vieira, Centro Hospitalar Universitário do Porto (CHUP)

Ophthalmology department of Centro Hospitalar Universitário do Porto (CHUP), Oporto, Portugal

Isabel Sampaio, Centro Hospitalar Universitário do Porto (CHUP)

Centro Hospitalar Universitário do Porto (CHUP), Porto, Portugal

Maria João Menéres, Centro Hospitalar Universitário do Porto (CHUP)

Centro Hospitalar Universitário do Porto (CHUP), Porto, Portugal


Buffault J, Baudouin C, Labbé A. XEN® Gel Stent for management of chronic open angle glaucoma: A review of the literature. Journal Français d'Ophtalmologie.2019. Feb; 42(2): e37-e46. https://doi.org/10.1016/j.jfo.2018.12.002

Kalina AG, Kalina PH, Brown MM. XEN® Gel Stent in Medically Refractory Open-Angle Glaucoma: Results and Observations After One Year of Use in the United States. Ophthalmology and Therapy, 2019 Sep;8(3):435-446. https://doi.org/10.1007/s40123-019-0192-8

Fea, AM, Durr GM, MaroloP, Malinverni L, Economou MA, Ahmed I. XEN® Gel Stent: A Comprehensive Review on Its Use as a Treatment Option for Refractory Glaucoma. Clinical ophthalmology (Auckland, N.Z.) 2020.14, 1805-1832. https://doi.org/10.2147/OPTH.S178348

Theillac V, Blumen-Ohana E, Akesbi J, Hamard P, Sellam A, Brasnu E. et al. Cataract and glaucoma combined surgery: XEN® gel stent versus nonpenetrating deep sclerectomy, a pilot study. BMC Ophthalmology. 2020; 20(1), 231. https://doi.org/10.1186/s12886-020-01492-z

Lavia C, Dallorto L, Maule M, Ceccarelli M, Fea AM, Virgili G. Minimally-invasive glaucoma surgeries (MIGS) for open angle glaucoma: A systematic review and meta-analysis. PLOS ONE. 2017. 12(8), e0183142. https://doi.org/10.1371/journal.pone.0183142

Sandhu S, Dorey MW. Case report: Xen ab interno gel stent use in a refractory glaucoma patient with previous filtration surgeries. J Glaucoma. 2018;27(3):e59-e60. https://doi.org/10.1097/IJG.0000000000000864

Ferreira NP, Pinto JM, Teixeira F, Pinto LA. XEN Gel Stent Early Failure-dye-enhanced Ab-externo Revision. Journal of current glaucoma practice. 2018; 12(3), 139-141. https://doi.org/10.5005/jp-journals-10078-1237

Stoner AM, Capitena Young CE, SooHoo JR, Pantcheva MB, Patnaik JL, Kahook MY, Seibold LK. A Comparison of Clinical Outcomes After XEN Gel Stent and EX-PRESS Glaucoma Drainage Device Implantation. J Glaucoma. 2021 Jun 1;30(6):481-488. https://doi.org/10.1097/IJG.0000000000001823

Wagner FM, Schuster AK, Emmerich J, Chronopoulos P, Hoffmann EM. Efficacy and safety of XEN®-Implantation vs. trabeculectomy: Data of a "real-world" setting. PLoS One. 2020 Apr 20;15(4):e0231614. https://doi.org/10.1371/journal.pone.0231614

Theilig T, Rehak M, Busch C, Bormann C, Schargus M, Unterlauft JD. Comparing the efficacy of trabeculectomy and XEN gel microstent implantation for the treatment of primary open-angle glaucoma: a retrospective monocentric comparative cohort study. Scientific reports. 2020., 10(1), 19337. https://doi.org/10.1038/s41598-020-76551-y

Marcos Parra MT, Salinas López JA, López Grau NS, Ceausescu AM, Pérez Santonja JJ. XEN implant device versus trabeculectomy, either alone or in combination with phacoemulsification, in open-angle glaucoma patients. Graefes Arch Clin Exp Ophthalmol. 2019 Aug;257(8):1741-1750. https://doi.org/10.1007/s00417-019-04341-y

Wang B, Leng X, An X, Zhang X, Liu X, Lu X. XEN gel implant with or without phacoemulsification for glaucoma: a systematic review and meta-analysis. Annals of translational medicine. 2020; 8(20), 1309. https://doi.org/10.21037/atm-20-6354

Ibáñez-Muñoz A, Soto-Biforcos VS, Rodríguez-Vicente L, Ortega-Renedo I, Chacón-González M, Rúa-Galisteo O. et al XEN implant in primary and secondary open-angle glaucoma: A 12-month retrospective study. European Journal of Ophthalmology. 2020 Sep;30(5):1034-1041. https://doi.org/10.1177/1120672119845226

Prum BE, Jr., Rosenberg LF, Gedde SJ, et al. Primary Open-Angle Glaucoma Preferred Practice Pattern(®) Guidelines. Ophthalmology 2016;123:P41-p111. https://doi.org/10.1016/j.ophtha.2015.10.053

Marques RE, Ferreira NP, Sousa DC, Pinto J, Barata A, Sens P, Abegão Pinto L. Glaucoma Gel Implant Learning Curve in a Teaching Tertiary Hospital. J Glaucoma. 2019 Jan;28(1):56-60. https://doi.org/10.1097/IJG.0000000000001107

Karimi A, Lindfield D, Turnbull A, Dimitriou C, Bhatia B, Radwan M. et al. A multi-centre interventional case series of 259 ab-interno Xen gel implants for glaucoma, with and without combined cataract surgery. Eye (Lond). 2019 Mar;33(3):469-477. https://doi.org/10.1038/s41433-018-0243-8

Heidinger A, Schwab Ch, Lindner E, Riedl R, Mossböck G. Retrospective Study of 199 Xen45 Stent Implantations From 2014 to 2016. Journal of Glaucoma. 2019; 28(1), 75-79. https://doi.org/10.1097/IJG.0000000000001122



How to Cite

Vieira R, Figueiredo A, Sampaio I, Menéres MJ. XEN gel stent ® in the management of glaucoma: preliminary results of a tertiary center. J.ophthalmol.(Ukraine) [Internet]. 2023 Feb. 28 [cited 2023 Mar. 24];(1):9-13. Available from: https://ua.ozhurnal.com/index.php/files/article/view/3



Clinical Ophthalmology