maximal medical therapy, surgical intervention was pursued. Although repositioning the iStent with the same inserter used to place the device at the time of implantation is well known, there is no elaboration in the literature on the technique used for removal in a delayed case like ours. To avoid utilizing an iStent to generate a free inserter in such cases of removal, we describe a technique using microintraocular forceps to safely and effectively remove the iStent.A literature review using the search term "iStent" indicates that this is the first reported case of recurrent hyphema secondary to a malpositioned iStent with subsequent refractory and persistently elevated IOP. Management of delayed cases can prove difficult given the potential surgical complexity of removing the iStent without the inserter. We present a method of using the Katena Prasad micro-intraocular 23G straight forcep to remove the implant to resolve the recurrent hyphema and refractory increased IOP.
This case study reports the successful implantation of the Xen ab interno gel stent in a 44-year-old man with refractory chronic open-angle glaucoma. The patient had multiple unsuccessful filtration surgeries including a trabeculectomy and 2 Ahmed glaucoma valves placed superotemporally and inferonasally oculus dexter. The patients intraocular pressure was reduced from 29 mm Hg preoperatively to 17 mm Hg 1 year after surgery, without any ocular complications. The Xen gel stent may be considered as a possible intervention to lower intraocular pressure in patients with refractory glaucoma, despite previous filtration surgeries if the superonasal conjunctiva is spared and healthy.
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