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Purpose  The outer stent lumen can be located either deeper (in or under Tenon's layer) or more superficially in the conjunctival stroma after the transscleral  XEN  Glaucoma Gel Microstent ( XEN ‐ GGM ; Allergan Plc.,  USA ) implantation. The present study aimed to investigate the effect of the postoperative conjunctival implant position on surgical success and intraocular pressure ( IOP ) after  XEN ‐ GGM .    Methods  Prospective data from 66 consecutive open‐angle glaucoma eyes of 54 patients were collected preoperatively and 1 and 2 weeks, and 1, 6 and 12 months postoperatively. The layer of implantation was determined in the first month postoperatively as  intra‐ and subtenon  or  intraconjunctival  depending on the location of the outer lumen of the stent in  OCT  (Visante  OCT ; Zeiss, Germany). Primary outcome measures were differences in relative  IOP  reduction at 12 months between the two groups. Further, complete and qualified surgical success, number of secondary needlings and number of  IOP ‐lowering medications and absolute  IOP  were assessed.    Results  Relative  IOP  reduction was higher in  intra‐ and subtenon  group ( n  =   37/66, 56%) at week 1 (−54% versus −19%, p < 0.001), week 2 (−39% versus −21%, p = 0.02), month 1 (−42% versus −28%, p = 0.035) and month 12 (−39% versus −24%, p = 0.024). The mean absolute  IOP  was lower in  intra‐ and subtenon group  at week 1 (10.8 [95% CI , 8.8–14.1] versus 16.6 [95% CI , 14.1–19.0] mmHg, p < 0.001) and months 12 (13.9 [95% CI , 12.4–15.4] versus 16.7 [95% CI , 14.6–18.8] mmHg, p = 0.041). At month 6, a lower burden for  IOP ‐lowering medication was shown for the intra‐ and subtenon group (0.2 ± 0.5 versus 1.0 ± 1.1, p = 0.034). The mean number of secondary needlings, which were done in 47/66 (71%) of the eyes, was lower in the  intra‐ and subtenon  group in the first year (1.9 ± 1.7 versus 1.2 ± 1.2, p = 0.03). Qualified surgical success was higher in the  intra‐ and subtenon  group (90% versus 61%, p = 0.01) after 1 year.    Conclusion  The present study demonstrates a higher efficacy achieved with lower secondary needling rates in deeper implant positions in conjunctiva after  XEN ‐ GGM .

Effect of the outer stent position on efficacy after minimally invasive transscleral glaucoma gel stent implantation