Outcomes of XEN Gel Stent Implantation in the Inferonasal Quadrant after Failed Trabeculectomy
Eyüp Düzgün, Ali Olgun, Murat Karapapak, Abdurrahman Alpaslan Alkan, Melih Ustaoğlu
Citation Information :
Düzgün E, Olgun A, Karapapak M, Alkan AA, Ustaoğlu M. Outcomes of XEN Gel Stent Implantation in the Inferonasal Quadrant after Failed Trabeculectomy. J Curr Glaucoma Pract 2021; 15 (2):64-69.
Aim and objective: To evaluate the efficacy and safety of XEN stent implantation in the inferonasal quadrant after prior failed trabeculectomy.
Materials and methods: Fourteen open-angle glaucoma patients with prior failed trabeculectomy were recruited to this retrospective study. Implantation of the stent was performed as a stand-alone procedure. The mean follow-up duration was 14.2 months. Best-corrected visual acuity, intraocular pressure (IOP), number of medications, complications, and the requirement for additional procedures were among the outcome measures recorded.
Results: Mean IOP reduced by 49.3% from 24.14 ± 2.74 mm Hg preoperatively to 12.23 ± 2.89 mm Hg at month 12 (p < 0.001). Medication usage reduced from 3.71 ± 0.47 medications preoperatively to 1.31 ± 1.55 at month 12 (p = 0.003). Adverse events included transient slight intracameral hemorrhage (5 eyes, 35.7%), second trabeculectomy required (2 eyes, 14.3%), and numerical hypotony (IOP <5 mm Hg, in 3 cases, 21.4%), all of which resolved spontaneously. Six eyes (42.8%) required postoperative bleb needling to further reduce IOP. There were no cases of vision loss, stent exposure, hypotony, lower eyelid malposition, bleb dysesthesia, or bleb-related infection.
Conclusion: XEN gel stent implantation in the inferonasal quadrant can be considered a viable surgical option for patients with a history of previously failed trabeculectomy requiring further IOP lowering.
Clinical significance: To the best of our knowledge, this is the first case series describing the outcome of inferonasal implantation of XEN gel stent following failed trabeculectomy.
Addis V, Zhang M, Miller-Ellis E. New glaucoma surgical procedures. Adv Ophthalmol Optom 2016;1(1):389–410. DOI: 10.1016/j.yaoo.2016.03.009.
Lewis RA. Ab interno approach to the subconjunctival space using a collagen glaucoma stent. J Cataract Refract Surg 2014;40(8):1301–1306. DOI: 10.1016/j.jcrs.2014.01.032.
Tan S, Walkden A, Au L. One-year result of XEN45 implant for glaucoma: efficacy, safety, and postoperative management. Eye 2018;32(2):324–332. DOI: 10.1038/eye.2017.162.
Schlenker MB, Gulamhusein H, Conrad-Hengerer I, et al. Efficacy, safety, and risk factors for failure of standalone ab interno gelatin microstent implantation versus standalone trabeculectomy. Ophthalmology 2017;124(11):1579–1588. DOI: 10.1016/j.ophtha.2017.05.004.
Hengerer FH, Kohnen T, Mueller M, et al. Ab interno gel implant for the treatment of glaucoma patients with or without prior glaucoma surgery: 1-year results. J Glaucoma 2017;26(12):1130–1136. DOI: 10.1097/IJG.0000000000000803.
Grover DS, Flynn WJ, Bashford KP, et al. Performance and safety of a new ab interno gelatin stent in refractory glaucoma at 12 months. Am J Ophthalmol 2017;183:25–36. DOI: 10.1016/j.ajo.2017.07.023.
Karimi A, Hopes M, Martin KR, et al. Efficacy and safety of the ab-interno Xen gel stent after failed trabeculectomy. J Glaucoma 2018;27(10):864–868. DOI: 10.1097/IJG.0000000000001044.
Sandhu S, Dorey MW. Case report: Xen ab interno gel stent use in a refractory glaucoma patient with previous filtration surgeries. J Glaucoma 2018;27(3):e59–e60. DOI: 10.1097/IJG.0000000000000864.
Tailor R, Lalias T. A case of refractory neovascular glaucoma treated with a XEN 45 implant. J Glaucoma 2018;27(10):929–930. DOI: 10.1097/IJG.0000000000001033.
Hengerer FH, Auffarth G, Conrad-Hengerer I. Comparison of minimally invasive XEN45 gel stent implantation in glaucoma patients without and with prior interventional therapies. Ophthalmol Ther 2019;8(3):447–459. DOI: 10.1007/s40123-019-0193-7.
Hengerer FH, Auffarth G, Conrad-Hengerer I. Nasal superior versus nasal inferior implantation of the Xen45 gel stent – one year results. J Ophthalmol Vision Res 2019;1(1):1–7.
Saheb H, Gedde SJ, Schiffman JC, et al. Outcomes of glaucoma reoperations in the tube versus trabeculectomy (TVT) study. Am J Ophthalmol 2014;157(6):1179–1189. DOI: 10.1016/j.ajo.2014.02.027.
Gedde SJ, Herndon LW, Brandt JD, et al. Postoperative complications in the tube versus trabeculectomy (TVT) study during five years of follow-up. Am J Ophthalmol 2012;153(5):804–814.e1. DOI: 10.1016/j.ajo.2011.10.024.
Olgun A, Duzgun E, Yildiz AM, et al. XEN Gel Stent versus trabeculectomy: short-term effects on corneal endothelial cells. Eur J Ophthalmol 2020;31(2):346–353. DOI: 10.1177/1120672120924339.
Widder RA, Dietlein TS, Dinslage S, et al. The XEN45 Gel Stent as a minimally invasive procedure in glaucoma surgery: success rates, risk profile, and rates of re-surgery after 261 surgeries. Graefes Arch Clin Exp Ophthalmol 2018;256(4):765–771. DOI: 10.1007/s00417-018-3899-7.
Fea A, Cannizzo PM, Consolandi G, et al. Managing drawbacks in unconventional successful glaucoma surgery: a case report of stent exposure. Case Rep Ophthalmol Med 2015;2015:847439. DOI: 10.1155/2015/847439.
Galal A, Bilgic A, Eltanamly R, et al. XEN glaucoma implant with mitomycin C 1-year follow-up: result and complications. J Ophthalmol 2017;2017:5457246. DOI: 10.1155/2017/5457246.
Sekaran A, Karimi A, Lindfield D. Hypertrophic dysaesthetic blebs following ab-interno gel stent (Xen) glaucoma surgery: management and ‘redirect’ revision surgery. Clin Exp Ophthalmol 2018;46(9):1093–1095. DOI: 10.1111/ceo.13335.
Fernandez-Garcia A, Romero C, Garzon N. “Dry Lake” technique for the treatment of hypertrophic bleb following XEN® gel stent placement. Arch Soc Esp Oftalmol (English Edition) 2015;90(11):536–538. DOI: 10.1016/j.oftal.2015.03.003.
Budenz DL, Hoffman K, Zacchei A. Glaucoma filtering bleb dysesthesia. Am J Ophthalmol 2001;131(5):626–630. DOI: 10.1016/s0002-9394(00)00901-6.
Martino AZ, Iverson S, Feuer WJ, et al. Surgical outcomes of superior versus inferior glaucoma drainage device implantation. J Glaucoma 2015;24(1):32. DOI: 10.1097/IJG.0b013e318287ac8f.
Rachmiel R, Trope GE, Buys YM, et al. Intermediate-term outcome and success of superior versus inferior Ahmed glaucoma valve implantation. J Glaucoma 2008;17(7):584–590. DOI: 10.1097/IJG.0b013e31816299bc.
Karimi A, Lindfield D, Turnbull A, et al. A multi-centre interventional case series of 259 ab-interno Xen gel implants for glaucoma, with and without combined cataract surgery. Eye 2019;33(3):469–477. DOI: 10.1038/s41433-018-0243-8.
Mansouri K, Guidotti J, Rao HL, et al. Prospective evaluation of standalone XEN gel implant and combined phacoemulsification-XEN gel implant surgery: 1-year results. J Glaucoma 2018;27(2):140–147. DOI: 10.1097/IJG.0000000000000858.
Olgun A, Imamoglu S, Karapapak M, et al. Endophthalmitis after XEN gel stent implantation: 2 cases. J Glaucoma 2018;27(12):e191–e194. DOI: 10.1097/IJG.0000000000001076.
Kim E-A, Law SK, Coleman AL, et al. Long-term bleb-related infections after trabeculectomy: incidence, risk factors, and influence of bleb revision. Am J Ophthalmol 2015;159(6):1082–1091. DOI: 10.1016/j.ajo.2015.03.001.
Soltau JB, Rothman RF, Budenz DL, et al. Risk factors for glaucoma filtering bleb infections. Arch Ophthalmol 2000;118(3):338–342. DOI: 10.1001/archopht.118.3.338.
Caronia RM, Liebmann JM, Friedman R, et al. Trabeculectomy at the inferior limbus. Arch Ophthalmol 1996;114(4):387–391. DOI: 10.1001/archopht.1996.01100130383004.
Lenzhofer M, Strohmaier C, Hohensinn M, et al. Longitudinal bleb morphology in anterior segment OCT after minimally invasive transscleral ab interno glaucoma gel microstent implantation. Acta Ophthalmol (Copenh) 2019;97(2):e231–e237. DOI: 10.1111/aos.13902.
Picht G, Grehn F. Classification of filtering blebs in trabeculectomy: biomicroscopy and functionality. Curr Opin Ophthalmol 1998;9(2):2–8. DOI: 10.1097/00055735-199804000-00002.