I have been working with the Xen45 gel stent (AqueSys; not FDA approved) for approximately 18 months and prior to that with its predecessor, the Xen 63. I have implanted more than 60 Xen45 devices. Unexpectedly, I have found it particularly beneficial in younger patients (25-60 years old) with marked IOP elevation who do not have significant optic nerve damage. From my perspective, the Xen comes closer to competing with trabeculectomy than other devices that I have used in the microinvasive glaucoma surgery category, though unlike the others, adjunctive mitomycin C is also required. I have seen IOPs of more than 50 mm Hg reduced to the low teens with this device. Trabeculectomy still remains a more effective option for low-failure-risk patients with advanced glaucoma requiring low target pressures. I also use the Xen in cataract patients who have advanced glaucoma controlled by multiple medications. With the Xen, postoperative IOP spikes and hypotony are avoided, and the procedure is significantly less invasive than trabeculectomy.

Keith Barton, MD, FRCP, FRCS
• consultant ophthalmic surgeon, Glaucoma Service, Moorfields Eye Hospital, London
• keith@keithbarton.co.uk
• financial disclosure: consultant to AqueSys