XEN45 Gel Stent Implantation for Refractory Glaucoma Following Penetrating Keratoplasty: A Prospective Study with Over One Year Follow-Up

Introduction To evaluate the efficacy and safety of XEN45 gel stent implantation for medically refractory glaucoma following penetrating keratoplasty (PK).Methods In this prospective single-center study, 13 eyes with uncontrolled post-PK glaucoma underwent XEN45 implantation. Outcomes included intraocular pressure (IOP) reduction, medication use, success rates, and complications. Success was defined as IOP >5 and <21 mmHg with a >20% reduction from baseline, without (complete) or with (qualified) medications. Follow-up was at least one year.Results Preoperative IOP [median 31 mmHg, Interquartile Range (IQR): 29–45.5 mmHg] was significantly reduced to 16.1 mmHg (IQR: 11.5–25.5 mmHg) at 12 months (p = .008) and to 12.7 mmHg (IQR: 9.3–19.6 mmHg) at 18 months (p = .031), excluding patients who required secondary glaucoma surgery. The median number of glaucoma medications decreased from 4 (IQR: 3.5–4.0) preoperatively to 0 (IQR: 0–1.8) at 12 months (p = .008) and 0 (IQR: 0–1.3) at 18 months (p = .031) in the same subgroup. At 12 months, the cumulative complete and qualified success rates were 38.5% and 46.2%, respectively; at 18 months, the corresponding rates were 38.5% and 46.2%. The most common complication was bleb scarring (46.2%). No new corneal graft opacification occurred.Conclusions XEN45 gel stent implantation significantly reduces IOP and medication burden in refractory glaucoma after PK. It demonstrates an acceptable safety profile with no new cases of corneal graft opacification observed during follow-up. XEN45 implantation is an effective and valuable minimally invasive approach for refractory post-PK glaucoma.