Key Takeaways
- Both ab externo and ab interno approaches significantly reduced IOP.
- Medication use declined similarly with both techniques.
- Ab externo implantation was associated with lower needling rates.
Both ab externo and ab interno XEN45 Gel Stent implantation techniques achieved similar reductions in intraocular pressure (IOP) and medication use, but the ab externo approach was associated with a significantly lower needling rate, according to a new systematic review and meta-analysis that compared the techniques.
Researchers conducted a comprehensive search and screened 216 articles of which 6 retrospective studies met inclusion criteria. The analysis included 614 eyes, with 318 treated using the ab externo approach and 278 treated using the ab interno technique.
Mean patient age was similar between groups, though the ab externo cohort included a higher proportion of female patients. Both approaches achieved significant reductions in IOP. The pooled standardized mean difference (SMD) for IOP reduction was -12.8 in the ab externo group and -10.1 in the ab interno group. Both techniques also resulted in significant and comparable decreases in the number of IOP-lowering medications required postoperatively, with SMDs of -2. for ab externo and -2.1for ab interno.
Needling rates were significantly lower with the ab externo approach compared to ab interno (12.1% vs 18.1%, P = 0.04). Although secondary glaucoma surgeries were more frequent in the ab interno group (19.8% vs 11.6%), the difference was not statistically significant (P = 0.28).
Reference
Hubayni R, Qedair J, Aljahdali FF, et al. Efficacy and Safety of Ab-externo Approach versus Ab-interno Approach of XEN45 Gel Stent Implantation: A Systematic Review and Meta-Analysis. Clin Ophthalmol. 2026;20:575562. doi: 10.2147/OPTH.S575562. PMID: 41773281; PMCID: PMC12949973.
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