xen-implant: minimally invasive surgery for the treatment of glaucoma · 2018-06-11 ·...
TRANSCRIPT
XEN-IMPLANT: MINIMALLY INVASIVE SURGERY FOR THE TREATMENT OF GLAUCOMA
Dr. André Mermoud,Glaucoma Center,
VISIO-Lausanne, Switzerland
SAOO-Kongress1.3.18
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The 4 aims of any glaucoma surgery are:
The 4 [E]
[E] fficient in reducing the IOP[E] asy surgery if possible[E] xclusion of complications[E] ffective for a long time
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Concept of Minimally Invasive Glaucoma Surgeries «MIGS»
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InnFocus (Arrow) implant
XEN-gel tube
Concept of Minimally Invasive Glaucoma Surgeries «MIGS»
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Concept of Minimally Invasive Glaucoma Surgeries «MIGS»
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CyPass implant
Concept of Minimally Invasive Glaucoma Surgeries «MIGS»
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All MIGS have in common: increased cost of surgeriesBecause they all need a surgical device (1000 – 1800chf)
MIGS: Minimally Invasive Glaucoma Surgeries
MIGS: Minimally Effective Glaucoma Surgeries
MIGS: Maximal Income for Glaucoma Syndicate
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2010 -2018
Concept of Minimally Invasive Glaucoma Surgeries «MIGS»
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First implantation : January 2015
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Lateral movement of the injector may lead to misplacement
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First post-op day
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Montchoisi Study: 2015-2017
149 Eyes / Xen T.12 Visits ( Before surgery, day 1, day 3, 1 week, 1, 2, 3, 6, 9, 12, 18, 24, 36 months
Medical and surgical treatment before: 128/149 (86%) patients were receiving anti-glaucoma therapy0 med: 21 (14%)1 med: 30 (20%)2 meds: 48 (32%)3 meds: 31 (21%)4 meds: 19 (13%)Pre-op anti-glaucoma Surgery: 2 DSCI
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Total number of patients: 149
Age (years): 75.02 +/- 9.9 (49-95)
Sex: F 106 (71%), M 43,(29%)
Ethnicity: Caucasian: 143Black: 1 Asian: 3Hispanic: 2
Diagnostics: POAG: 57PEXG: 53PACG: 24NPG: 2Others: 13
Montchoisi Study: 2015-2017
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R/L eye RE: 75 (50.3%)LE: 74 (49.7%)
Visual Field: MD: 7.69 +/- 5.9CLV: 4.85 +/- 2.2
C/D ratio: 0.77 +/- 0.15
Type of surgery: Combined: 109 patients (73%)Glaucoma surgery alone: 40 patients (27%)
Montchoisi Study: 2015-2017
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149 146 95 122 121 75 99 44 22 0107 104 65 87 85 58 64 31 18 042 42 30 35 36 17 35 13 4 00
20
40
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0.0
5.0
10.0
15.0
20.0
25.0
Before Day 1 Day 3 1 Week 1 Month 3 Months 6 Months 12 Months 18 Months 24 Months
Mean IOP based on each visits All patientsCombined surgeriesGlaucoma alone
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0.0
5.0
10.0
15.0
20.0
25.0
30.0
Preop D1 D3 W1 M1 M3 M6 M12 M18
Mea
n IO
P [m
mHg
]
Follow-up time
Mean IOP Combined XEN + XEN only
Combined (n=107)
XEN (n=41)
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0.0
10.0
20.0
30.0
40.0
50.0
60.0
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88 91 94 97 100
103
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136
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142
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148
151
154
IOP beforeIOP after 3 patients with more than 21
0.05.0
10.015.020.025.0
Before After (allvalues)
Average Value (All values)
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0.0
10.0
20.0
30.0
40.0
50.0
60.0
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88 91 94 97 100
103
106
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Plot IOP (Only success)
IOP before and after in patients with sucess (all IOP < 21 mm Hg)
0.0
5.0
10.0
15.0
20.0
25.0
Before After (onlySuccess)
Average Value (Only success)
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014%
122%
229%
323%
412%
GLAUCOMA TREATMENT BEFORE
085%
112%
23%
30%
40%
GLAUCOMA TREATMENT AFTERALL DATA
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27
17
Needlings in combined and in simple glaucoma
17 (39%) in glaucoma surgeries
27 (25%) in combined surgeries
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Needling and MMC injectionwith topical and sub-conjunctival anaesthesia
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Needling and MMC injection with topical anaesthesia
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COMPLICATIONS
Operative complications:- Hyphema induced by injector mis-manipulation: 5 (3%)- Lost of tube 1 (<1%)
Post-operative complications- Hypertony: 3 (2%)- Hypotony: 2 ( both had choroidal detachments (1.3%)- Encysted bleb: 4 (1.6%)- Needling: 17 and 27 (39% and 25%) glaucoma/combined
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ConclusionsGood median-term results
Few complications
Long-term results ??
iPhone immaging
iPhone immaging
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The 4 aims of any glaucoma surgery are:
The 4 [E]
[E] fficient YES[E] asy surgery if possible YES[E] xclusion of complications YES[E] fficient for a long time ???
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XEN-Tube and Deep Sclerectomy in ICE- syndrome
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To reduce the risk of hypotony and later corneal decompensationAfter Baerveldt tube implantation
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Take home message:XEN-gel Implant:
- Is a real MIGS- Offers low post-op pressure- Is followed by minimal complications- First day: good IOP and good vision- Long-term results to be yet studied
- Can be proposed - When medication is not well tolerated- When compliance is poor- In conjunction with phaco in patients with early glaucoma
- Should not be used in- In secondary glaucoma- In patients needing very low IOP- If you don’t like to do needliongs
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MCQ 1
MIGS stands for
A: Minimally Invasive Glaucoma Surgery
B: Maximum Income for Glaucoma Surgeons
C: Minimally Effective Glaucoma Surgery
D: Maximum Income for Glaucoma Industry
E: Minimum Time in surgical Theater
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MCQ 2
XEN-gel Tube
A: Can be used in all type of glaucoma
B: Can replace trabeculectomy
C: Offers the same advantages than deep sclerectomy
D: Can replace Baerveldt implant
E: Can replace medical therapy of glaucoma
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MCQ 3
XEN-gel Tube should be used when:
A: Patients are not compliant
B: Glaucoma is progressing despite maximal medical therapy
C: Patient doesn’t want a major glaucoma surgery (Trab., DS, Tube)
D: first day post-op Vision should not be affected
E: You like to do needlings