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Master Thesis

Efficacité et sécurité de la chirurgie mini-invasive du glaucome par implant XEN® : une étude rétrospective

Abstract : Purpose : The objective of this study was to evaluate the efficacy and safety of minimally invasive glaucoma surgery by XEN implant with or without cataract surgery in the treatment of chronic open angle glaucoma. Methods : This monocentric retrospective study included all patients who underwent XEN implantation with or without cataract surgery from February 2017 to May 2018. The primary outcome was complete and qualified success rate at 12 months. Complete success was defined as a postoperative intraocular pressure ≤18mmHg and a postoperative intraocular pressure reduction ≥20% from preoperative baseline without any glaucoma medications or any secondary glaucoma surgery. Qualified success was defined as a postoperative intraocular pressure ≤18mmHg and a postoperative intraocular pressure reduction ≥20% from preoperative baseline with or without glaucoma medications without any secondary glaucoma surgery. Needling revisions were not considered surgical failure. Secondary outcome measures included: postoperative intraocular pressure, postoperative intraocular pressure reduction from preoperative baseline, number of postoperative glaucoma medications, needling rate and postoperative complications. Results: One hundred thirty-eight eyes of 116 patients were included in the study, 86 (62.3%) XEN were implanted alone and 52 (37.7%) were implanted during a combined intervention with phacoemulsification. Ninety eyes (65.2%) had a complete 12-month follow-up. The complete and qualified success rate at 12 months was 50% and 60% respectively. Mean intraocular pressure decreased from 24 mmHg preoperatively to 16 mmHg at 12 months. The mean intraocular pressure reduction was 28.7% at 12 months. The mean number of glaucoma medications decreased from 3.3 preoperatively to 0.7 at 12 months. Sixty-one eyes (44.2%) underwent a needling revision. Sixteen eyes (11.6%) requiring secondary glaucoma surgery and 1 case of late onset endophthalmitis complicating blebitis with implant exposure were reported. Conclusion : The implantation of XEN appears to be a safe and effective surgical technique that reduces intraocular pressure and the number of glaucoma medications at 12 months of follow-up with a low complication rate but frequent use of needling revisions that, like any glaucoma filtering surgery, requires close follow-up of patients after surgery.
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Master Thesis
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Thomas Adam. Efficacité et sécurité de la chirurgie mini-invasive du glaucome par implant XEN® : une étude rétrospective. Organes des sens. 2019. ⟨dumas-02967348⟩

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