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Postoperative outcomes of open conjunctival Ab-externo XEN implantation with tenonectomy.

Nicholas A Johnson, James C Liu, Ang Li, Leon W Herndon

Purpose: The goal of this study is to detertmine the efficacy and safety of ab-externo XEN implantation with tenonectomy.

Patients and methods: Patients who underwent ab-externo implantation by a single surgeon (LWH) between February 2019 and December 2020 were included in this retrospective cohort study. Intraocular Pressure (IOP) and glaucoma medication use were collected at postoperative day 1, month 1, month 3, month 6, and month 12. Baseline IOP and medications were compared to postoperative IOP and medications at each time point. Odds of success stratified by patient race and combined vs. standalone procedures were compared at time of last follow-up.

Results: Forty-four eyes of 38 patients were included in this study. Baseline IOP was 20.6 ± 7.2 mmHg. Baseline medication use was 2.5 ± 1.2 medications. Twenty-three eyes had one year follow-up data. Twelve eyes failed prior to POM12. Those that reached POM12 had a mean IOP at POM12 of 14.2 ± 4.0 mmHg (p<0.001) and mean medication use of 1.2 ± 1.4 medications (p<0.001). There were 5 complete successes, 10 qualified successes, and 20 failures at POM12. The odds of failure for whites compared to blacks at POM12 was 2.63 (95% CI=0.63, 11). The odds of failure for solo XEN implantation compared to XEN combined with cataract surgery was 0.93 (95% CI=0.23, 3.82).

Conclusions: Ab-externo XEN implantation with tenonectomy appears to be a safe and effective means of achieveing IOP control and reducing glaucoma medication burden. Success rates using this technique are comparable to previous studies which utilize an ab-interno approach.