A rare case of endophthalmitis after bleb needle revision for glaucoma Xen<sup>®</sup> gel stent

Napoli, Luca; Riva, Ivano; Oddone, Francesco; Michelessi, Manuele; Quaranta, Luciano

doi:10.1177/1120672119878016

Cited by 10 publications

(8 citation statements)

References 10 publications

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“…Other complications that have been reported in the context of XEN ® 45 implantation procedures were device fracture during needling [20], endophthalmitis [21], or degradation of the device [22], but we are happy to report that none of them occurred in our case series, nor was there any procedural failure (defined as presence of a secondary IOP lowering procedure or loss of light perception) [18] during the three-year follow-up period that made it necessary to replace the gel stent. Comparing our outcomes with other studies found in the literature, De Gregorio [16] (XEN ® 63 implantation procedures) reported an 11.8% failure rate, whereas Lenzhofer had 10% of failed XEN ® 63 implantation surgeries [18].…”

Section: Discussionmentioning

confidence: 99%

Comparing Medium-Term Clinical Outcomes following XEN® 45 and XEN® 63 Device Implantation

Fernández-García¹,

Zhou²,

García-Alonso

et al. 2020

Journal of Ophthalmology

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Purpose. To evaluate medium-term clinical outcomes with XEN® 45 or XEN® 63 Gel Stent (Allergan, Dublin, Ireland) for treatment of primary open angle glaucoma (POAG). Materials and Methods. Retrospective, descriptive, and observational study involving 40 patients implanted with a XEN® 45 Gel Stent and 34 implanted with a XEN® 63 Gel Stent who had undergone POAG surgery and had been followed up and controlled between 12 and 36 months. Results. IOP dropped from 18.02 ± 5.23 mmHg preop to 13.81 ± 1.88, 14.80 ± 2.23, and 14.62 ± 1.90 at 1, 2, and 3 years after surgery (p<0.001) consecutively with XEN® 45 and from 19.00 ± 6.11 mmHg preop to 15.47 ± 2.45, 14.66 ± 2.45, and 15.46 ± 2.48 at 1, 2, and 3 years after surgery (p<0.001) with XEN® 63. The number of drugs used by patients to treat their glaucoma decreased after undergoing surgery in both groups. Within the XEN® 45 group, mean changes at 1 year, 2 years, and 3 years amounted to 70%, 74.3%, and 37.5%, respectively, whereas within the XEN® 63 group, the mean reduction was 75%, 79.8%, and 71.9%. When comparing the outcomes for two groups, the differences did not prove to be statistically significant. More than 90% of the procedures included in the study (using either gel-stent device) were completed without any noteworthy complications. Conclusion. POAG surgical procedures with either XEN® 45 or XEN® 63 Gel Stent implantation could be a safe and effective treatment approach.

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Section: Discussionmentioning

confidence: 99%

Comparing Medium-Term Clinical Outcomes following XEN® 45 and XEN® 63 Device Implantation

Fernández-García¹,

Zhou²,

García-Alonso

et al. 2020

Journal of Ophthalmology

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“…Notably, this patient also had nonpenetrating trauma with a vegetable twig 1 week before the incident, which may have contributed to his presentation. 52 In practice, some surgeons place the XGS ab-externo, and others place it ab-interno. Furthermore, some surgeons incise the conjunctiva to place the XGS, while others make corneal incisions.…”

Section: Rates Of Infection After Migsmentioning

confidence: 99%

“…2 The incidence of endophthalmitis after GDI surgery ranges in the literature from 0.24% to 7.7% (Table 1). 46 There are multiple isolated case reports of acute endophthalmitis (within Trabeculectomy 21,24,26,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] 0.12-7.5 ∼15 Glaucoma drainage implant 27,[46][47][48] 0.24-7.7 ∼7-11 Microinvasive glaucoma surgery (bleb-forming) [49][50][51][52][53][54][55] 0-3 Most reports are late infection (limited data) Microinvasive glaucoma surgery (non-bleb-forming) [56][57][58][59][60] 0-0.3 Most reports are acute infection (limited data)…”

Section: Rate Of Infection After Gdi Surgerymentioning

confidence: 99%

Intracameral Antibiotics and Glaucoma Surgery

Marando¹,

Neeson²,

Valle³

2022

International Ophthalmology Clinics

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surgery. 21 Despite these statistics, there is no consensus in the glaucoma community regarding IC antibiotic prophylaxis. ' Infection in Glaucoma Surgeries Timing of Infection IC antibiotics only have utility in preventing acute postoperative endophthalmitis. Under ideal conditions, IC antibiotics maintain a minimum inhibitory concentration for up to ∼30 hours in the anterior chamber (AC). 22 In the literature, acute infections are defined as occurring <4 to 6 weeks following surgery, whereas late infections occur > 6 weeks postoperatively. Late infections are more common than acute infections following trabeculectomy 23 and are often associated with bleb leaks. 24,25 In one study, only 15% (10/68) of cases of bleb-associated endophthalmitis (BAE) occurred within 1 month of surgery. 26 Late infections are also more common than acute infections following GDI surgery and are often associated with late tube exposures. 27,28 Since MIGS are relatively new, and the devices vary, it is unclear whether endophthalmitis will more often be acute (like after traditional cataract surgery) or late (like after traditional glaucoma surgery). This will probably vary based on whether a conjunctival bleb is formed, like in the case of the XEN Gel Stent (XGS) (Allergan, Abbvie Company, Irvine, CA, USA), and whether corneal incisions are made, which can act as a gateway for periocular bacteria in the immediate postoperative period. Even though late infections tend to be common, acute infections still confer significant morbidity for glaucoma patients.In fact, acute postoperative endophthalmitis occurs 3 times as often following glaucoma surgery than cataract surgery according to data from the Intelligent Research in Sight (IRIS) registry from 2013 to 2017. Before the widespread adoption of IC antibiotics for cataract surgery, the rate of acute endophthalmitis was 0.08% for cataract surgery and 0.12% for glaucoma filtering surgeries. 29 After evidence supporting IC antibiotics in cataract surgery emerged, the rate of acute endophthalmitis halved to 0.04% following cataract surgery alone, but remained at 0.12% following cataract surgery combined with glaucoma surgery. This may be because IC antibiotics have not been studied in the setting of glaucoma surgery, though this has yet to be determined. 21 Since, theoretically, only acute infections are prevented by the use of IC antibiotics, Table 1 summarizes the estimated incidence of overall and acute infection for each of the major glaucoma surgeries. Rate of Infection After TrabeculectomyTrabeculectomy is the second most common glaucoma surgery following MIGS. 1,2 The exact rate of infection after trabeculectomy is 126 ' Marando et al

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“…The incidence of endophthalmitis after filtering surgery with MMC has been reported to be from 2.1% to 2.6% and may occur from the first few days after surgery to decades later [28,29]. Endophthalmitis following XEN Gel Stent implantation is rare, but various cases have been published [16,24,25,[30][31][32][33].…”

Section: Infection/endophthalmitismentioning

confidence: 99%

Navigating Challenges after Xen

Vera¹,

Shah

Smith

et al. 2021

CTOY

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The XEN Gel Stent is a surgical implant for the treatment of glaucoma unresponsive to maximum tolerated medical therapy, with higher predictability and fewer sight-threatening complications than trabeculectomy or tube shunts. While complications following XEN implantation may be less common than in other glaucoma procedures, they are not completely avoidable. This paper elaborates the most commonly reported complications following XEN implantation with an aim to mitigate their occurrence by understanding the pathophysiology behind them. In addition, the authors provide insights from the literature and their own experience and make recommendations for management when complications do occur.

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A rare case of endophthalmitis after bleb needle revision for glaucoma Xen^® gel stent

Cited by 10 publications

References 10 publications

Comparing Medium-Term Clinical Outcomes following XEN® 45 and XEN® 63 Device Implantation

Comparing Medium-Term Clinical Outcomes following XEN® 45 and XEN® 63 Device Implantation

Intracameral Antibiotics and Glaucoma Surgery

Navigating Challenges after Xen

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A rare case of endophthalmitis after bleb needle revision for glaucoma Xen® gel stent

Cited by 10 publications

References 10 publications

Comparing Medium-Term Clinical Outcomes following XEN® 45 and XEN® 63 Device Implantation

Comparing Medium-Term Clinical Outcomes following XEN® 45 and XEN® 63 Device Implantation

Intracameral Antibiotics and Glaucoma Surgery

Navigating Challenges after Xen

Contact Info

Product

Resources

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A rare case of endophthalmitis after bleb needle revision for glaucoma Xen^® gel stent