11/28/2018 1 Comment Dr. Karen Shelton Performs Central Alabama's First Xen Gel Minimally Invasive Glaucoma StentWe are always excited to lead the way in offering advanced procedures for your patients. Last week, Dr. Karen Shelton performed the first Xen Gel Minimally Invasive Glaucoma Stent in central Alabama. We sat down with Dr. Shelton to get her thoughts on the Xen and discuss the procedure. What are some of the key benefits that Xen Gel Stents offer our glaucoma patients? As you probably know, XEN was first Launched in 2017 following FDA approval in November 2016. It is the only approved MIG device that allows for subconjunctival filtration. Most MIG devices are approved for mild to moderate glaucoma performed in conjunction with cataract surgery. The nice thing about Xen is that it has a wider label for approval including 'refractory' glaucoma patients who have failed previous glaucoma surgery or patients with POAG, PDS, or PXF with angles unresponsive to maximum tolerated medical therapy. It can also be performed as a stand-alone procedure or in conjunction with cataract surgery. These both offer a lot of advantages. What results should we expect to see with the Xen Gel stent? In a pivotal trial, patients with Refractory Glaucoma (which included prior Trabeculectomy, Tube Shunts, Canaloplasty, Trabeculotomy) that underwent XEN surgery had their IOP reduced from a MEAN baseline of 25.1 mmHg (+3.77) to 15.9 mmHg (+5.2 mmHg) at 12 Months. It's really nice to see this kind of IOP lowering effect in a minimally invasive device. Despite it's effective IOP Lowering, it's restrictive flow helps to avoid hypotony that we sometimes see in patients undergoing trabeculectomy. What are some of the other advantages of Xen? What I especially like about the Xen Gel stent is that it doesn't create problems if additional glaucoma filtering surgeries like trabeculectomy or tubes are required. The conjunctiva is spared from any significant manipulation or potential scarring. In addition, the postop course on these patients is substantially less involved than a typical trabeculectomy or tube. I think this will definitely open opportunities for more co-management of these cases since we shouldn't run in to the challenging complications that are sometimes associated with other procedures. Finally, I really like to maximize refractive outcomes of our cataract patients with or without combined glaucoma surgery. More advanced procedures like trabeculectomy or tubes can induce or shift astigmatic correction which can make this challenging. Less invasive procedures like Xen can allow us to maximize these refractive outcomes while, at the same time, provide a great lowering of IOP. Tell us about the patient from last week. She was an interesting patient. She is a moderate to severe glaucoma patient with a history of poor compliance and significant autoimmune disease. She has moderately thin corneas, significant optic nerve damage as well as moderate cataracts. The surgery went really well. I removed the cataract and implanted the Xen stent without any problems. At her one-day post-op visit, IOP measured 8mm Hg with a diffuse bleb superior nasally, well centered IOL and an otherwise very quiet eye. I anticipate that she will continue to do really well and she is already looking forward to having the other eye done in the next few weeks. We are excited to offer advanced glaucoma surgical procedures like the Xen Gel Stent for your patients. Click the link below to view a video of the Xen Gel insertion. https://www.youtube.com/watch?v=tCNh86fHEXY&feature=youtu.be If you have any questions about the Xen or other glaucoma patients, please don't hesitate to give us a call or you can drop Dr. Shelton an email at [email protected].
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7/3/2020 08:25:55 am
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