XEN-45 Gel Stent Versus Trabeculectomy in Glaucoma: Gold-Standard Pathway Study (GPS)

Open to people ages 18 years and up

• Open-angle glaucoma where the Intraocular pressure (IOP) is not controlled when using topical IOP-lowering glaucoma medication
• Best-corrected baseline Snellen visual acuity of 20/80 or better
• Visual field mean deviation no worse than -15.0 dB
• Medicated IOP ≥18 mmHg and ≤44 mmHg
• Subjects not anticipated to require any ocular surgery (e.g., cataract surgery) in either eye up to 12 months from the time of inclusion
• Area of healthy, free, and mobile conjunctiva in the target area (superior bulbar conjunctiva)
• Trabecular meshwork must be visible (with Shaffer angle grade ≥2 in the target quadrant)
• Failed ab-interno canal or suprachoroidal MIGS procedures (such as i-Stent, CyPass, GATT, ABiC, Kahook dual blade goniotomy, etc.) are allowed.

• Subject has active neovascular, uveitic or angle recession glaucoma or any glaucoma associated with vascular disorders
• Subject has had prior ab externo incisional glaucoma surgery (such as trabeculectomy, viscocanalostomy, canaloplasty, tube shunts of any type, collagen implants, etc.), conjunctival filtering surgery, transscleral cycloablative procedures (such as cyclophotocoagulation, micro pulse cyclophotocoagulation, cryotherapy, UC3, etc.) or prior major conjunctival surgery (i.e., scleral buckle)

-. Clinically significant inflammation or infection within 30 days before the preoperative visit (e.g., blepharitis, conjunctivitis, severe ocular surface disease, keratitis, uveitis, herpes simplex infection)

• Presence of conjunctival scarring or prior conjunctival surgery or other conjunctival pathologies (e.g., pterygium) in the target area
• History of corneal surgery, corneal opacities, or corneal disease
• Central corneal thickness ≤490μm or ≥620μm
• Vitreous present in the anterior chamber
• Aphakic
• Subject has had prior intraocular surgery in either eye within ≤3 months before the preoperative visit (including phacoemulsification)
• History of complicated cataract surgery (e.g. with visual impairment, e.g. vitreous loss, ACIOL, perhaps sutured IOL or scleral fixated IOL, prior CME, etc.)
• Presence of intraocular silicone oil
• Active diabetic retinopathy, proliferative retinopathy, choroidal neovascularization, branch retinal vein occlusion, central retinal vein occlusion, geographic atrophy, or other ophthalmic disease or disorder that could confound study results or impaired episcleral venous drainage (e.g., Sturge-Weber or nanophthalmos, Axenfeld-Reiger, ICE, etc.
• Known or suspected allergy or sensitivity to drugs required for the protocol (including anesthesia), or any of the device components (e.g., bovine or porcine products, or glutaraldehyde)
• Pregnant or nursing women and those planning a pregnancy during the study period.
• Participation in another drug or device clinical trial concluding within 30 days before the preoperative visit