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New research · Ophthalmology
Therapeutic advances in ophthalmology · 18h
Meta-analysisTherapeutic advances in ophthalmology · 2026

Comparative efficacy and safety of ab-interno XEN 45 gel implantation versus trabeculectomy for glaucoma: a systematic review and meta-analysis.

Muhammad Imaz Bhatti, Maria Qadri, Ariba Asif … Hashem Abu Serhan
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OphthalmologyMeta-analysis

Trabeculectomy is associated with greater eye pressure reduction than XEN gel stent for glaucoma

Comparative efficacy and safety of ab-interno XEN 45 gel implantation versus trabeculectomy for glaucoma: a systematic review and meta-analysis.

Muhammad Imaz Bhatti … Hashem Abu Serhan
Therapeutic advances in ophthalmology · 2026
Background

Trabeculectomy remains the standard surgical treatment for glaucoma, but is associated with postoperative complications.

Purpose

To compare the efficacy and safety of ab-interno XEN 45 gel stent implantation versus trabeculectomy in patients with glaucoma.

Methods

Systematic review and meta-analysis.

n = 1260 eyes
Results

trabeculectomy lowered eye pressure more than the XEN stent

MD by subgroup · 95% CI
null = 0
reduction
-2.16
number of antiglaucoma medications
-0.03
More results

No significant difference was observed in the number of antiglaucoma medications (MD: -0.03 (95% CI: -0.23 to 0.18); I 2 = 53%).

More results

Rates of hyphema, choroidal detachment, hypotony, flat anterior chamber, bleb revision, and reoperation showed no statistically significant differences between procedures, although substantial heterogeneity was observed for hyphema ( I 2 = 60%), hypotony ( I 2 = 76%), and reoperation ( I 2 = 53%).

“
Conclusion · 1 of 2

Trabeculectomy achieves greater intraocular pressure reduction and higher surgical success rates than ab-interno XEN45 gel stent implantation, whereas XEN is associated with lower rates of selected bleb-related complications.

Conclusion · 2 of 2

Procedure selection should be individualized according to target intraocular pressure, glaucoma severity, and postoperative management requirements.

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