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. 2021 May-Aug;15(2):64-69.
doi: 10.5005/jp-journals-10078-1304.

Outcomes of XEN Gel Stent Implantation in the Inferonasal Quadrant after Failed Trabeculectomy

Eyüp Düzgün  1 , Ali Olgun  2 , Murat Karapapak  1 , Abdurrahman Alpaslan Alkan  3 , Melih Ustaoğlu  4
Affiliations

Outcomes of XEN Gel Stent Implantation in the Inferonasal Quadrant after Failed Trabeculectomy

Eyüp Düzgün et al. J Curr Glaucoma Pract. 2021 May-Aug.

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.

How to cite this article: Düzgün E, Olgun A, Karapapak M, et al. Outcomes of XEN Gel Stent Implantation in the Inferonasal Quadrant after Failed Trabeculectomy. J Curr Glaucoma Pract 2021;15(2):64-69.

Keywords: Inferonasal quadrant; Minimally invasive glaucoma surgery; Refractory glaucoma; Trabeculectomy; XEN gel stent.

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Conflict of interest statement

Source of support: Nil Conflict of interest: None

Figures

Fig. 1
Fig. 1
Graph shows the change in mean IOP and number of medications from baseline to the 12-month follow-up visit. IOP, intraocular pressure
Figs 2A to D
Figs 2A to D
A) The XEN gel stent (arrow) is visible under the conjunctiva with a flat bleb in the right eye; (B) The appearance of an inferonasally located diffuse filtering bleb (*) in the left eye at month 12; (C) Anterior segment photography after XEN stent surgery in the patient who had undergone two failed trabeculectomies and Ex-Press shunt surgery; (D) View of the XEN gel stent in the iridocorneal angle on gonioscopy in the same patient
See this image and copyright information in PMC

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