36-month multi-centre outcomes of XEN45 gel stent implantation in Asian versus non-Asian eyes with primary open angle glaucoma.

PURPOSE: Ethnicity has been shown to influence outcomes of bleb-forming glaucoma filtering surgery. This study evaluated 3-year outcomes of XEN45 Gel Stent (XGS) in Asian versus non-Asian eyes with primary open angle glaucoma (POAG).

METHODS

This multicentre, retrospective cohort included 117 eyes with POAG undergoing XGS implantation, with or without concomitant phacoemulsification, between January 2017 and March 2023. Eyes were categorized as Asian or non-Asian based on recorded ethnicity. The primary outcome was cumulative surgical success at three years using survival analyses across intraocular pressure (IOP) thresholds (≤ 18, ≤ 15, and ≤ 12 mmHg with ≥ 20% reduction from baseline). Secondary analysis incorporating a medication reduction goal was performed. Secondary outcomes included longitudinal changes in IOP and medications, predictors of time-to-failure, and postoperative interventions and complications. Longitudinal outcomes were analysed using linear mixed-effects models. Multivariable Cox proportional hazards models evaluated predictors of failure.

RESULTS

92 Asian and 25 non-Asian eyes were included. Both groups demonstrated sustained reductions in IOP and medication burden over 36 months. Three-year cumulative success rates were comparable between Asian and non-Asian eyes across all success definitions (AR-18: 72.2% vs. 76.5%; AR-15: 72.7% vs. 76.5%; AR-12: 68.6% vs. 63.9%; all p > 0.30). No significant differences in cumulative success were observed between Phaco-XEN and standalone XEN procedures. Ethnicity and concomitant phacoemulsification were not independently associated with time-to-failure. Post-operative interventions and complications were infrequent.

CONCLUSION

XGS demonstrated no significant differences in 3-year surgical success, safety, and durability between broadly categorized Asian and non-Asian eyes with POAG. Neither ethnicity nor concomitant phacoemulsification independently influenced failure risk.