Clinical Report: Xen Study Finds Ab Interno and Externo Approaches Equally Effective

Overview

A retrospective review of the Xen gel stent revealed that both ab interno and ab externo surgical approaches are equally effective in reducing intraocular pressure (IOP), lowering medication requirements, and improving best-corrected visual acuity (BCVA) over a follow-up period of up to three years.

Background

The management of glaucoma often involves surgical interventions aimed at lowering IOP and improving patient outcomes. Understanding the effectiveness of different surgical approaches, such as the ab interno and ab externo techniques for the Xen gel stent, is crucial for optimizing treatment strategies. This study contributes to the growing body of evidence supporting the use of minimally invasive glaucoma surgeries (MIGS) in clinical practice.

Data Highlights

No significant differences were found between the ab interno and ab externo approaches in terms of IOP reduction, medication burden, or visual acuity improvement over three years.

Key Findings

• Both surgical approaches effectively reduced IOP and medication use.
• There was no statistically significant difference in outcomes between the two techniques at any follow-up point up to three years.
• Best-corrected visual acuity improved equivalently for both methods.
• Surgeons can choose either technique based on personal preference without compromising patient outcomes.
• Long-term follow-up data supports the use of Xen gel stent in glaucoma management.

Clinical Implications

Surgeons can confidently utilize either the ab interno or ab externo approach for Xen gel stent implantation, knowing that both methods yield similar clinical outcomes. This flexibility allows for individualized surgical planning based on the surgeon's expertise and patient-specific factors.

Conclusion

The findings reinforce the equivalence of ab interno and ab externo approaches for the Xen gel stent, highlighting the importance of surgeon preference in achieving optimal patient outcomes.

References

1. Pazos M, Traverso CE, Viswanathan A, et al., 2026 -- Advancing glaucoma care: What's new in the 6th edition of the European Glaucoma Society guidelines
2. Efficacy and Safety of Ab-externo Approach versus Ab-interno Approach of XEN45 Gel Stent Implantation: A Systematic Review and Meta-Analysis - PMC
3. Comparison of XEN45 Gel Stent Outcomes in Glaucoma: Ab Externo Open-Conjunctiva Approach with Ologen vs. Ab Interno Closed-Conjunctiva Approach | MDPI
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9. Efficacy and Safety of Ab-externo Approach versus Ab-interno Approach of XEN45 Gel Stent Implantation: A Systematic Review and Meta-Analysis - PMC
10. Comparison of XEN45 Gel Stent Outcomes in Glaucoma: Ab Externo Open-Conjunctiva Approach with Ologen vs. Ab Interno Closed-Conjunctiva Approach | MDPI