# Microshunt Matchup: XEN vs. PRESERFLO in the Arena of Primary Open-Angle Glaucoma

## TL;DR

This paper compares two minimally invasive glaucoma devices, XEN and PRESERFLO, finding that PRESERFLO may offer better long-term results in reducing eye pressure and medication use.

## Contribution

A comparative analysis of XEN and PRESERFLO in primary open-angle glaucoma management, focusing on long-term efficacy and safety.

## Key findings

- PRESERFLO achieved a 39% IOP reduction compared to 28% with XEN after two years.
- PRESERFLO reduced medication use by 69%, compared to 62% with XEN.
- PRESERFLO had fewer post-operative interventions like needling (5% vs. 20% with XEN).

## Abstract

Minimally invasive bleb-forming procedures, such as the XEN® Gel Stent and the PRESERFLO™ MicroShunt, are surgical options used to lower intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG). This review compares the safety and efficacy of the two devices.

A literature search was conducted using Ovid Medline and Embase. Studies were included if they were published in journals with an impact factor above 1.5 and reported outcomes at least 6 months after implantation of XEN or PRESERFLO. Only adult patients with POAG were included. The main outcomes assessed were mean IOP reduction, change in the number of glaucoma medications, and the occurrence of key complications or further interventions.

Both devices demonstrated consistent and clinically meaningful IOP reduction in published studies. In a two-year, single-centre retrospective study, 41 eyes treated with XEN showed IOP reduction from 19.2 ± 4.4 mmHg to 13.8 ± 3.8 mmHg (a 28% reduction). In the same study, PRESERFLO in 41 eyes lowered IOP from 20.1 ± 5.0 mmHg to 12.1 ± 3.5 mmHg (a 39% reduction). The average number of medications decreased by approximately 62% with XEN and 69% with PRESERFLO. After 24 months, about 62% of XEN eyes and 64% of PRESERFLO eyes no longer required medications. Early hypotony, defined as IOP ≤ 5 mmHg, occurred in 24% of XEN and 39% of PRESERFLO cases. Persistent hypotony was reported in about 8% of XEN cases. Needling was more common after XEN (20%) than after PRESERFLO (5%). At two years, XEN studies showed around 28% IOP reduction, whereas PRESERFLO studies reported IOP lowering of about 35-39% over the same period.

In conclusion, both PRESERFLO and XEN are effective options for managing POAG. However, PRESERFLO may offer more consistent IOP reduction, greater medication-use reduction, and fewer post-operative interventions, making it a potentially more reliable long-term option.