EGS 2026: Rapid Fire abstracts highlight long-term surgical outcomes, AI screening, and post-injection IOP risk

Rapid Fire abstracts presented at EGS 2026 highlighted long-term XEN 45 outcomes, AI-supported glaucoma screening and increased post-injection intraocular pressure spike risk in patients with prior glaucoma clinic attendance.

EGS 2026 in Brussels brought together a wide-ranging program of plenary discussions, hands-on skills sessions and updates on surgical and medical approaches to glaucoma care. Among the Rapid Fire abstract sessions, several presentations stood out for their potential relevance to day-to-day practice, including 10-year outcomes after XEN 45 gel stent implantation, the use of artificial intelligence (AI) in glaucoma screening and the management of intraocular pressure (IOP) spikes after intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections.

Don’t miss out on hearing about our latest peer-reviewed articles, expert opinions, conference news, podcasts and more.

Register Register

Ten-year XEN 45 data show sustained IOP and medication reductions in selected patients

Long-term outcomes after minimally invasive and bleb-forming glaucoma procedures remain an important area of interest for clinicians, particularly as treatment decisions increasingly balance IOP lowering, medication burden and the likelihood of further intervention.¹

In one Rapid Fire abstract, Chiavetta and colleagues reported 10-year results from a prospective, single-center study evaluating XEN 45 gel stent implantation in patients with open-angle glaucoma. The study included 170 consecutive eyes of 126 patients who underwent XEN implantation either alone or combined with phacoemulsification because of uncontrolled IOP or disease progression despite medical treatment.

At 10 years, 71 eyes completed follow-up. Mean medicated IOP decreased from 20.5 ± 7.7 mmHg at Baseline to 12.6 ± 5.4 mmHg, representing a 34.8% reduction. The mean number of ocular hypotensive medications also decreased, from 1.9 ± 1.2 at Baseline to 0.9 ± 1.1 at 10 years, a reduction of 52%.

Complete surgical success, defined as unmedicated IOP ≤15 mmHg with at least a 20% reduction from medicated Baseline, was achieved in 25% of eyes. Qualified success, allowing fewer ocular hypotensive medications than at Baseline, was achieved in 41%. However, the findings also underline the need for long-term follow-up and postoperative management, with needling performed in 68% of eyes and secondary surgical intervention required in 32%.

Overall, the study suggests that XEN 45 gel stent implantation can provide clinically meaningful long-term IOP and medication reductions in a proportion of patients, while also highlighting that additional procedures remain common over extended follow-up.

AI model improves referral accuracy in glaucoma screening

The challenge of detecting glaucoma earlier without overwhelming specialist services was also addressed in a Rapid Fire abstract evaluating AI-supported screening.²

Pargana and colleagues assessed agreement between AI-based and human referral decisions in a prospective diagnostic agreement study of glaucoma screening in a primary care setting. Participants aged 55–65 years underwent non-mydriatic color fundus photography, with glaucoma risk calculated using the MONA G-Risk AI model. Referred participants then underwent comprehensive ophthalmic evaluation, with disease status assessed using Thessaloniki Eye Study criteria.

Among 671 patients analyzed, agreement between AI referral and confirmed glaucoma diagnosis was stronger than agreement between human referral and confirmed diagnosis. AI referral also more closely reflected the confirmed glaucoma prevalence, with an AI referral rate of 9.8% compared with confirmed glaucoma prevalence of 6.0%. Human referral was higher, at 17.6%.

The AI model demonstrated higher diagnostic accuracy than a single human grader, corresponding to one additional correct glaucoma diagnosis for every 96 screened patients. The abstract also reported low agreement between human graders on individual optic disc features, reinforcing the difficulty of scaling expert-led screening based on optic disc photography alone.

These findings support the potential role of AI in reducing unnecessary referrals and improving the efficiency of glaucoma screening pathways, particularly where access to specialist graders is limited.

Prior glaucoma clinic attendance linked to higher IOP spike risk after anti-VEGF injections

A large real-world analysis from Moorfields Eye Hospital explored whether previous glaucoma clinic attendance is associated with acute IOP spikes after intravitreal anti-VEGF injections.³

Viswanathan and colleagues analyzed 145,578 anti-VEGF injections delivered between January 2010 and January 2025, with complete pre- and post-injection IOP measurements. Included agents were aflibercept 2 mg, ranibizumab, ranibizumab biosimilar, faricimab and brolucizumab, with comparisons across vial and prefilled syringe formulations.

Overall, IOP spike rates were higher with syringe formulations than vials. IOP elevation of ≥10 mmHg occurred in 31.7% of injections delivered by syringe compared with 22.2% delivered by vial. Absolute post-injection IOP >40 mmHg occurred in 1.9% of syringe injections compared with 0.5% of vial injections.

Previous glaucoma clinic attendance was associated with significantly increased IOP spike risk across formulations and thresholds. For syringe formulations, the ≥10 mmHg spike rate increased from 30.6% in patients without prior glaucoma clinic attendance to 34.3% in those with prior attendance. For vial formulations, the rate increased from 20.6% to 26.2%.

The authors concluded that prior glaucoma clinic attendance is an independent risk factor for acute post-injection IOP elevation. For clinicians managing patients with glaucoma or ocular hypertension who also require intravitreal anti-VEGF therapy, the findings support careful IOP monitoring and consideration of prophylactic treatment in selected higher-risk patients.

References

1. Chiavetta E, Torbey J, Souza Mathias AC, et al. XEN 45 gel stent implantation in open angle glaucoma: 10-years results of a prospective study. Presented at: 17th European Glaucoma Society Congress, Brussels, May 30–June 2, 2026.
2. Pargana J, Wehbi Z, Lima-Cabrita A, et al. Overcoming barriers in glaucoma screening: agreement between AI-driven model and human experts performance. Presented at: 17th European Glaucoma Society Congress, Brussels, May 30–June 2, 2026.
3. Viswanathan T, Varshney T, Tynan D, et al. Impact of glaucoma clinic attendance on intraocular pressure spikes after intravitreal anti-VEGF injections: analysis of 145,578 injections. Presented at: 17th European Glaucoma Society Congress, Brussels, May 30–June 2, 2026.