Abstract:
　　The goal of glaucoma treatment is to maintain patients’ visual function and related quality of life at a sustainable cost. Current management of glaucoma may be suboptimal because some treated patients still go blind due to poor compliance or insufficient IOP reduction. Trabeculectomy has long been considered as the standard of filtering surgery to reduce intraocular pressure (IOP) in patients with medically refractory glaucoma. Although trabeculectomy is an effective and relatively safe procedure, the postoperative course and final outcome of trabeculectomy remains unpredictable. To implement filtering surgery at an earlier stage of the glaucoma treatment paradigm, procedures that are more predictable than the currently used ones are needed.
　　XEN45 gel, a microinvasive glaucoma surgery (MIGS) device, was designed to lower IOP through subconjunctival flow with an attempt to eliminate postoperative hypotony. XEN45 gel implantation can achieve comparable IOP control as trabeculectomy with similar safety profile although XEN45 gel may need more postoperative intervention such as needling. However, XEN45 gel implantation is associated with less tissue destruction and more rapid vision recovery comparing with trabeculectomy. These benefits may make XEN45 gel stent being implemented earlier in disease course to obtain lower and less variable IOP, ideally addressing the inadequacy of current glaucoma management - the under-treatment and noncompliance issues.
　　The preliminary experience of XEN45 gel implantation in Taipei Veterans General Hospital revealed that it effectively reduced IOP and glaucoma medication during the first year postoperatively. No serious complications were observed, but near half of the eyes required wound modification procedures. The final IOP control was related to the first month postoperative IOP. Close follow-up and meticulous postoperative wound modification during the first month is recommended to achieve long-term success of XEN surgery.