{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T08:57:59Z","timestamp":1785574679362,"version":"3.56.0"},"reference-count":45,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ophthalmol Eye Dis"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Trabeculectomy remains the standard surgical treatment for glaucoma, but is associated with postoperative complications. XEN gel stent implantation has emerged as a minimally invasive alternative, though comparative evidence regarding its efficacy and safety remains inconsistent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To compare the efficacy and safety of ab-interno XEN 45 gel stent implantation versus trabeculectomy in patients with glaucoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources and methods:<\/jats:title>\n                    <jats:p>A comprehensive literature search was conducted across PubMed, Embase, Scopus, the Cochrane Library, and Web of Science to identify studies comparing the XEN Gel Stent with trabeculectomy. Random-effects meta-analyses were performed using odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Eleven studies comprising 1260 eyes (645 XEN, 615 trabeculectomy) were included. Trabeculectomy achieved significantly greater intraocular pressure (IOP) reduction (MD: \u22122.16\u2009mmHg (95% CI: \u22122.88 to -1.44);\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2004=\u200443%) and higher qualified (OR: 1.59 (95% CI: 1.18 to 2.14);\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2004=\u20040%) and complete surgical success rates (OR: 1.72 (95% CI: 1.16 to 2.56);\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2004=\u200443%). No significant difference was observed in the number of antiglaucoma medications (MD: \u22120.03 (95% CI: \u22120.23 to 0.18);\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2004=\u200453%). 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 (\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2004=\u200460%), hypotony (\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2004=\u200476%), and reoperation (\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2004=\u200453%). XEN demonstrated significantly lower risks of bleb leakage and endophthalmitis but higher rates of bleb needling.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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. Procedure selection should be individualized according to target intraocular pressure, glaucoma severity, and postoperative management requirements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration:<\/jats:title>\n                    <jats:p>PROSPERO (CRD420251075034).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/25158414261472730","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T08:34:12Z","timestamp":1785400452000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative efficacy and safety of ab-interno XEN 45 gel implantation versus trabeculectomy for glaucoma: a systematic review and meta-analysis"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9381-0106","authenticated-orcid":false,"given":"Muhammad Imaz","family":"Bhatti","sequence":"first","affiliation":[{"name":"Faculty of Medicine, King Edward Medical University, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Qadri","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariba","family":"Asif","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, King Edward Medical University, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sana","family":"Iftikhar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Safiullah","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, King Edward Medical University, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erum","family":"Habib","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, Dow University of Health Sciences, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3109-2600","authenticated-orcid":false,"given":"Husam","family":"Abu Dawood","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Palestine Polytechnic University, Wadi Al-Hariyyah, Hebron P720, Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hashem Abu","family":"Serhan","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.3192"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2014.05.013"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1442-9071.2012.02773.x"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjophth-2021-000830"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41433-025-03636-1"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/aos.16697"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/APO.0000000000000646"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.3238\/arztebl.m2024.0240"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0183142"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/1120672120924339"},{"issue":"4","key":"e_1_3_4_12_2","article-title":"Efficacy and safety of Ab interno XEN gel implant after a failed filtering surgery","volume":"65","author":"Franco FGS","year":"2021","unstructured":"Franco FGS, Branchetti M, Spagnuolo V, et al. 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