Surgical Outcome Comparison of Open Conjunctival Ab Externo Xen 45 Gel Stent Implantation vs Trabeculectomy in Open-angle Glaucoma.

Aim: To evaluate the safety, efficacy, and risk factors for failure compared between trabeculectomy and open conjunctival ab externo Xen 45 gel stent (XGS AEO) placement. Methods: For this retrospective single-center study, we included eyes of patients >18 years old with open-angle glaucoma and baseline intraocular pressure (IOP) >17 mm Hg who received trabeculectomy or XGS AEO placement. We excluded aphakic eyes and those missing preoperative data. The primary outcome was the rate of success (6 ≤ IOP ≤ 21 mm Hg, plus ≥20% IOP reduction from baseline, with or without ocular hypotensive medications) after 1 year, compared between groups. Alternative IOP upper limits were 18 and 15 mm Hg. Secondary outcomes were risk factors for failure, complications, and postoperative interventions. Results: We studied 82 trabeculectomy eyes and 34 XGS AEO eyes. At 1 year, 62%, 61%, and 49% of trabeculectomy eyes and 72%, 69%, and 31% of XGS AEO eyes achieved success using IOP upper limits of 21, 18, and 15 mm Hg, respectively. There were no 1-year intergroup differences in IOP, IOP percent change, visual acuity, complications, or revision surgeries. Medication use was higher in the XGS AEO group. Prior trabeculoplasty was associated with a lower risk for failure in the XGS AEO group, but an increased risk in the trabeculectomy group. More eyes in the trabeculectomy group underwent manipulations postoperatively (p = 0.020). Conclusion: Open conjunctival ab externo Xen placement is similar in efficacy and safety to trabeculectomy. Clinical significance: The similar outcomes and fewer postoperative manipulations of XGS AEO implantation compared to trabeculectomy make it a reasonable surgical option in open-angle glaucoma. How to cite this article: Applebaum SS, Hundito A, Teng CC, et al. Surgical Outcome Comparison of Open Conjunctival Ab Externo Xen 45 Gel Stent Implantation vs Trabeculectomy in Open-angle Glaucoma. J Curr Glaucoma Pract 2025;19(4):158-167.