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Case Reports
. 2019 May-Aug;13(2):79-81.
doi: 10.5005/jp-journals-10078-1253.

Migration of XEN45 Implant: Findings, Mechanism, and Management

Zaria C Ali  1 , Dawnn I Khoo  2 , Francessco Stringa  2 , Vikas Shankar  2
Affiliations
Case Reports

Migration of XEN45 Implant: Findings, Mechanism, and Management

Zaria C Ali et al. J Curr Glaucoma Pract. 2019 May-Aug.

Abstract

Aim: The aim of this study is to report the mechanism of XEN migration and its management.

Background: Over the past decade, new less invasive surgical approaches for glaucoma have been devised and carried out successfully. One such technique is the use of the XEN gel stent. We present a rare and relatively unknown complication of XEN migration and present in detail the likely mechanism by which this occurs, and its subsequent management.

Case description: A 73-year-old male with primary angle closure on maximal medical treatment presented with an intraocular pressure of 30 mm Hg in the left eye. The visual acuity was 6/5, iridocorneal angles were open in all four quadrants, and the cup disc ratio was 0.4. As phacoemulsification alone was unlikely to adequately lower intraocular pressures, the patient underwent combined phacoemulsification and XEN implantation. Although the patient had a good postoperative result with pressures lowered to 11 mm Hg, 4 months after the operation, the XEN was found to have migrated 4 mm into the anterior chamber, associated with a low-grade uveitis. The patient subsequently had the XEN explanted a new XEN inserted. Pressures lowered 1 month postoperatively to 14 mm Hg.

Conclusion: XEN migration is likely due to a combination of mechanical and frictional forces. If the XEN is positioned such that more than 2 mm is in the subconjunctival space, the XEN is likely to be angled upward and, therefore, be more susceptible to these forces and undergo migration.

Clinical significance: It is essential that XEN implants are correctly sited and that this is confirmed intraoperatively to prevent the need for further procedures.

How to cite this article: Ali ZC, Khoo DI, et al. Migration of XEN45 Implant: Findings, Mechanism, and Management. J Curr Glaucoma Pract 2019;13(2):79-81.

Keywords: Complications; Minimally invasive procedure; Surgical treatment; XEN.

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Conflict of interest statement

Source of support: Nil Conflict of interest: None

Figures

Figs 1A to C
Figs 1A to C
XEN position preoperatively and findings intraoperatively; (A) XEN migration forward, causing 4 mm of the implant to be visible in the anterior chamber; (B) Conjunctival bleb from the XEN tip showing the XEN tip (blue arrow); (C) The broken tip after attempted repositioning can be seen
Fig. 2
Fig. 2
Result of second surgery 4 weeks postoperatively; a good diffuse bleb is seen and the XEN has maintained a good position
Figs 3A and B
Figs 3A and B
How the position of the XEN may be affected. The yellow represents the XEN implant; (A) The XEN when placed 1 mm within the anterior chamber, 2 mm within the sclera and 3 mm within the subconjunctival space forms a well-shaped bleb, and has a stable position; (B) When the XEN is placed more anteriorly the XEN is angled obliquely and is more likely to be subject to forces from blinking, friction and microtrauma
See this image and copyright information in PMC

References

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