What does this research mean for the field?

Placement of the XEN Gel Stent within the scleral spur or ciliary body band yields greater intraocular pressure reduction and aqueous humor outflow compared to placement above the scleral spur, without increasing major complications. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to assess how the position of the Gel Stent affects its functionality and the reduction of intraocular pressure postoperatively.

July 2, 2026Open Access

Functional assessment of the XEN® Gel Stent relative to the implant position using non-invasive stress testing and automated gonioscopy

LMLeonie MahrenholtzHumboldt-Universität zu Berlin RHRobin HörleHumboldt-Universität zu Berlin SWSibylle WinterhalterHumboldt-Universität zu Berlin

Key Points

This study aims to assess how the position of the Gel Stent affects its functionality and the reduction of intraocular pressure postoperatively.
Single-center, prospective cohort study with 63 Gel Stent implantations from 09/2024 to 07/2025.
Stent positions categorized using automated gonioscopy 12 weeks post-operation.
Measured intraocular pressure reduction and aqueous humor outflow using standardized stress testing.
Intraocular pressure decreased from 22.2 ± 7.5 mmHg to 12.1 ± 5.1 mmHg at 12 weeks (p < 0.001).
Stress test IOP reduction increased from 14.8 ± 13.3% pre-implantation to 32.7 ± 19.7% at 12 weeks (p < 0.001).
Stents placed within scleral spur or ciliary body band (Grades 3 + 4) showed significantly greater outflow improvement than those placed higher (Grades 0-2) (p = 0.010).

Abstract

PURPOSE: Gel Stent position within the anterior chamber angle influences aqueous humor outflow and complication rates during the early postoperative period. METHODS: -63 Gel Stent implantation between 09/2024 and 07/2025 at Charité - Universitätsmedizin Berlin, Germany were included in this single-center, prospective cohort study. Eyes were categorized postoperatively according to stent position within the anterior chamber angle (Grades 0-4). Stent position was evaluated 12 weeks postoperatively through automated gonioscopy (GS-1, Nidek). Aqueous humor outflow was assessed using a standardized non-invasive stress test. Primary outcome was the intraocular pressure (IOP) reduction during stress test. Secondary outcomes included IOP reduction from baseline to 12 weeks postoperatively, number of glaucoma medications, complications and need for additional interventions. RESULTS: Gel Stent implantation from 22.2 ± 7.5 mmHg to 12.1 ± 5.1 mmHg 12 weeks postoperatively measured with Goldmann applanation tonometry (p < 0.001, Z -5.6). Stress test induced IOP reduction increased from 14.8 ± 13.3% pre-implantation to 32.7 ± 19.7% at 12 weeks (p < 0.001, CI -24.1 to -11.8). Eyes with stent placement within the scleral spur or ciliary body band (Grading 3 + 4, n = 34) had greater aqueous humor outflow improvement compared with eyes graded 0-2 (stent above scleral spur, n = 12) (p = 0.010, 95% CI -28.6 to -4.2). Postoperative transient hypotony occurred in 85.3% vs. 61.5% of eyes in Grading group 3 + 4 vs. 0-2 (p = 0.08). 4 eyes were considered non-functional due to malposition (Grading x). Mean number of glaucoma medications decreased from 2.8 ± 1.3 preoperatively to 0.2 ± 0.9 postoperatively. CONCLUSION: Gel Stent within the scleral spur or ciliary body band (Grade 3 + 4) was associated with greater pressure reduction during stress testing, suggesting an increased aqueous humor outflow in this study cohort. Such placement was associated with high treatment success and no increase in major complications, except the risk of misplacement, while transient hypotony was common.

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