Surgeon perspectives on learning ab-interno gelatin microstent implantation.

Objective: To evaluate and compare the surgeon's learning experience with an ab-interno gelatin microstent (XEN-45, Allergan) to other glaucoma surgeries.

Design: Cross-sectional survey study.

Methods: All surgeons in Canada who used the gelatin microstent were identified and given an anonymous online survey (FluidSurveys, Survey Monkey) designed to evaluate key factors associated with the device, including prior surgical experience, patient selection criteria, analysis of each surgical step, and postoperative care. The survey was validated using input from 3 experienced glaucoma surgeons.

Results: Surgeons were in early to mid-career (11.8 ± 7.2 operating years) and experienced with filtration surgery (94.1% very comfortable). Surgeons would more commonly operate on patients who had moderate to advanced disease (88.2% and 76.5% of surgeons felt appropriate to operate, respectively); had a diagnosis of primary open angle glaucoma or pseudoexfoliative glaucoma (70.6%); were on 2, 3, or 4 glaucoma medications (70.6%, 75.5%, 70.6%, respectively); and had previously undergone microinvasive glaucoma surgery (83.3%). Creation of the scleral tunnel into the subconjunctival space was rated the most difficult step of the surgery. Most surgeons (52.9%) required 6-10 cases to be comfortable with the procedure and felt it was easier to gain proficiency with ab-interno microstent implantation than traditional filtration surgery (94.1% agree or strongly agree).

Conclusion: The group of glaucoma surgeons surveyed felt it was easier to gain proficiency with gelatin microstent implantation than with traditional filtration surgery.