Journal of Current Glaucoma Practice

Register      Login

VOLUME 15 , ISSUE 2 ( May-August, 2021 ) > List of Articles

ORIGINAL RESEARCH

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.

DOI: 10.5005/jp-journals-10078-1304

License: CC BY-NC 4.0

Published Online: 30-09-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

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.


HTML PDF Share
  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. 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.
  13. 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.
  14. 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.
  15. 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.
  16. 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.
  17. 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.
  18. 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.
  19. 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.
  20. 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.
  21. 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.
  22. 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.
  23. 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.
  24. 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.
  25. 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.
  26. 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.
  27. 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.
  28. 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.
  29. 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.
  30. 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.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.