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Updates on XEN Gel Stent Implantation and Fixed-dose Combination Eye Drops

BY: Dr. Roy LauDec 22, 2022

Ocular surface disease (OSD) is a multifactorial disease of the ocular surface that results in symptomatic discomfort, visual disturbances, and tear film instability with progressive histopathologic and clinical changes to the ocular surface. OSD is common and appears frequently in patients with glaucoma. Essentially, the disease adversely affects patients’ quality of life and may affect subsequent success of glaucoma surgery. Hence, the control of OSD is important in addition to the control of intraocular pressure (IOP). Nonetheless, preservatives in glaucoma drops has been reported to trigger OSD. This highlights the unmet need in the management of glaucoma.

In the webinar titled “Latest updates on the XEN gel stent implantation and fixed-dose combination eye drops” organised by the Hong Kong Association of Private Eye Surgeons (HKAPES) dated 17-Nov 2022, innovative therapies for managing glaucoma had been discussed. Particularly, preoperative optimisation of ocular surface with preservative-free glaucoma drops was recommended. In this regard, the clinical benefits of preservative-free fixed combination of a prostamide plus timolol (BTFC PF) was highlighted. The therapy demonstrated non-inferiority and equivalence in IOP lowering compared with preservative-included formulation (BTFC), with no significant differences in safety and tolerability. Whereas, the BTFC was shown to have a greater overall ability to reduce IOP than other fixed combination therapies. Thus, the BTFC PF would facilitate better glaucoma practice by reducing OSD and provide more comfort to patients.

Besides, the clinical application of a Gel Stent implant designed to lower high eye pressure in open-angle glaucoma patients was presented during the lecture. The Gel Stent implant is a minimally invasive option for patients who had failed in previous surgical treatment and/or insufficiently managed with medications alone. In the APEX trial, it was demonstrated that the Gel Stent implant help achieve significant reduction and sustained low-to-mid teen IOP, whereas the efficacy of standalone treatment was comparable to cataract combined procedure. Of note, there was no case of severe hypotony was reported with the Gel Stent implant. The presentation summarised that the Gel Stent implant would achieve a better glaucoma practice by reducing OSD via significantly reducing number of eye drops, providing more comfort to patients, yet providing very strong IOP reduction to preserve vision.