The authors report a retrospective, non-randomised interventional case series of 39 patients who underwent a standalone XEN45 implantation. All 39 patients (female: male=1.2: 1) completed 12-month follow-up. Mean age was 70.1 years (range 32–92). Primary outcome measures were the intraocular pressure and the number of medications at one-year follow-up visit. Two IOP criteria were chosen to measure success: IOP ≤21mmHg and ≥20% reduction from baseline and IOP ≤15mm Hg and ≥30% reduction from baseline. The mean preoperative IOP was 24.9±7.8mmHg on three drops, which reduced to 14.5±3.4mmHg at month 12 (P<0.005) on 0.7 drops (P<0.005). On the basis of criteria one, the cumulative probability of success at one year was 87.0% without medication and 92.0% with medication. On the basis of criteria two, cumulative probability of success was 62.0% without medication and 64.0% with medication. Nineteen eyes (48.7%) required no bleb intervention at all during the follow-up period. The remaining 51.3% of eyes required bleb intervention with a median number of two episodes (range one to four). Bleb intervention with a median of two (range one to four) was required for 51.3% of eyes. Implant was obstructed by iris tissue in three eyes (7.7%); one eye (2.6%) developed hyphaema; eight eyes (20.5%) had numerical hypotony (IOP≤5 mmHg) at day one, of which all spontaneously resolved by week four apart from one eye. The proportion of eyes that met various target IOP levels at one-year follow-up of IOP ≤21, ≤18, ≤15 and ≤12mmHg regardless of medication (qualified success) were 95.0%, 92.0%, 66.6% and 25.6%, respectively. On the other hand, 56.4%, 56.2%, 51.3% and 25.6% of eyes, respectively, achieved those targets without medications (complete success). XEN45 implant has the potential of achieving a lower final IOP compared to other minimally invasive glaucoma surgery (MIGS) devices but is not as effective as the best reported results from modern trabeculectomy. It also comes with a higher complication rate and requires intensive postoperative management compared to other MIGS devices but has a better overall safety profile than trabeculectomy and a shorter surgical time. Limitation: short follow-up period. 

One-year result of XEN45 implant for glaucoma: efficacy, safety, and postoperative management.
Tan SZ, Walkden A, Au L.
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Sofia Rokerya

MBBS MRCOphth FRCSI, King's College University Hospital, UK.

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