Comparative Study of Trabeculectomy, PRESERFLO MicroShunt and XEN45 Gel Stent in Open‐Angle Glaucoma

Background To compare the safety and efficacy of trabeculectomy, PRESERFLO MicroShunt (PRESERFLO) and XEN45 Gel Stent (XEN) in patients with open‐angle glaucoma (OAG) during the first year. Methods A single‐centre retrospective case–control study included 384 eyes undergoing standalone glaucoma surgery (2013–2020). Propensity score matching was used to balance baseline covariates. The primary outcome was surgical success at 1 year. Complete success was two‐fold defined as an IOP of 6–15 or 6–18 mmHg, without loss of light perception, additional glaucoma surgery or IOP‐lowering medication; qualified success allowed medication and/or selective laser trabeculoplasty. Secondary outcomes included IOP, best‐corrected visual acuity, medication use and complications/interventions. Results We included 117 in the trabeculectomy, 82 eyes in the PRESERFLO group and 185 in the XEN group. Complete success was lower after XEN for both IOP criteria (44.0%, IOP 6–18 mmHg and 41.5%, IOP 6–15 mmHg) compared to trabeculectomy (59.8% and 59.3%, respectively; p < 0.05) and PRESERFLO (73.5% and 73.3%, respectively; p < 0.001). All procedures effectively and comparably reduced IOP to 12.3 ± 4.1 mmHg (trabeculectomy), 12.7 ± 3.5 mmHg (PRESERFLO), 13.4 ± 4.3 mmHg (XEN). The proportion of drop‐free patients was higher after PRESERFLO (81.0% vs. 58.6% and 56.6%, after trabeculectomy and XEN, respectively). Significant hypotony was uncommon and comparably so. Minor post‐operative interventions were more common in trabeculectomy patients compared with PRESERFLO and XEN. Conclusion This study suggests equal success rates for PRESERFLO and trabeculectomy, both outperforming XEN at 1 year, with fewer post‐operative interventions for PRESERFLO compared to trabeculectomy. Overall complication rates were comparable across groups.