Isolated versus combined XEN ‐implant surgery

Aims/Purpose: A minimally invasive surgical technique in glaucoma surgery is XEN implant. It allows direct evacuation of aqueous humour from anterior chamber to subconjunctival space. It is indicated in mild or moderate primary open angle glaucoma in patients with treatment with 2 or more active ingredients and good conjunctival status. The objective is to evaluate the effectiveness and safety of XEN implant isolated versus combined cataract surgery. Methods: Single‐centre retrospective observational study, conducted between 2018 and 2023. Follow‐up of 1 year in a sample of 44 eyes operated with XEN implant, 15 with isolated implant and 29 combined surgeries with cataract. Quantitative variables are expressed as mean ± standard deviation. Comparison between variables was performed using Student's t‐test after testing for normality of distribution using the Shapiro–wilk test. Results: Combined cataract surgery with respect to XEN implant placement showed no significant difference in visual acuity improvement, nor in the decrease in post‐surgical hypotensive treatment and intraocular pressure, except in the first month in favour of isolated surgery (p > 0.02). Follow‐up with visual field and optical coherence tomography showed no significant differences, suggesting that there was no progression of glaucoma with both techniques. There were no intraoperative complications. Needling manoeuvre was performed in 60% of patients with isolated XEN compared to 30% with combined surgery. Good safety profile. Other studies find no significant differences in the postoperative success rate between combined surgery or not with phacoemulsification, nor differences in outcomes in phakic versus pseudophakic patients. Conclusions: The XEN implant is effective and safe in terms of IOP lowering and the number of hypotensive drops. There are no significant differences in IOP lowering or in the number of drugs to be administered between the XEN implant alone and combined cataract surgery.