One-Year Outcomes of Repeat XEN Gel Stent Implantation for Prior XEN Failure: A Retrospective Study.

Purpose: To evaluate the 12-month outcomes of repeat XEN gel stent implantation in eyes with prior XEN failure. Patients and Methods: This single-center retrospective chart review included 24 eyes of 24 patients with a previously failed XEN stent, who underwent repeat XEN gel stent implantation between April 2019 and June 2023. Outcome measures included changes in mean intraocular pressure (IOP) and number of IOP-lowering medications from baseline (prior to repeat XEN) to postoperative 12 months, assessment of surgical success defined as achieving IOP ≤18 mmHg without medications (complete success)/on the same or fewer medications (qualified success), without secondary surgical intervention (SSI), and a morphologically functional bleb. Results: The mean age of patients was 65.3 ± 10.9 years. The study population was predominantly African American (79.2%). Among the eyes not requiring SSI, there was a 43.5% reduction in mean IOP from baseline to postoperative 12 months, which was statistically significant (23.50 ± 5.58 mmHg at baseline to 13.28 ± 3.54 mmHg at 12 months (p <0.001). The postoperative 12-month complete success rate was 16.7%, and the qualified success rate was 66.7%. The mean number of IOP-lowering medications also declined significantly from 3.00 ± 1.37 to 1.28 ± 1.13 (p = 0.002), revealing a 57% reduction from baseline to 12 months. No vision-threatening complications were reported. Conclusions: Repeat XEN gel stent implantation may be a viable surgical option for prior XEN failure, providing meaningful reductions in IOP and medication burden in majority of patients. These findings support consideration of a second XEN stent before transitioning to more invasive filtering surgeries.