Ab Interno Gel Implant–associated Bleb-related Infection

Kerr, Nathan M.; Wang, Jing; Sandhu, Amanjeet; Harasymowycz, Paul; Barton, Keith

doi:10.1016/j.ajo.2018.02.014

Cited by 22 publications

(15 citation statements)

References 9 publications

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“…The blebs were of moderate size, avascular in the first case, and in the second case, 2 mm of the Xen® Gel Stent was protruding from the conjunctiva. 16 Kerr et al 17 respectively reported three cases of blebitis occurring 8, 16 and 24 months after surgery, from which two of the patients developed endophthalmitis. Two of them showed an epithelial defect and leak, but the implant was not exposed, and explantation of the devices was not required.…”

Section: Discussionmentioning

confidence: 99%

Is the Xen® Gel Stent really minimally invasive?

Buffault

Baudouin

Labbé

2020

American Journal of Ophthalmology Case Reports

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Purpose To describe a case of severe Streptococcus pneumoniae endophthalmitis in a patient with a cystic, avascular filtering bleb who had been implanted with a Xen® Gel Stent 21 months previously. Observations A 64-year-old woman with open-angle glaucoma developed severe endophthalmitis 21 months after Xen® Gel Stent implantation. On presentation, visual acuity was limited to light perception. Examination revealed a 100% hypopyon, blebitis and an exposed stent, along with orbital cellulitis. Immediate explantation of the exposed Xen® was performed, and intravitreal antibiotics were administered. S. pneumoniae was isolated from an anterior chamber paracentesis. Based on the antibiogram, the patient was treated with topical fortified piperacillin, gentamicin and vancomycin along with appropriate systemic antibiotics (intravenous imipenem and oral levofloxacin). After 3 days of antibiotics, she received a daily intravenous bolus of methylprednisolone at a dose of 1 mg/kg/day for three days. Despite these measures, the patient's condition declined, with purulent melting of the globe requiring evisceration. Conclusionsand Importance As for other filtering surgeries, blebitis and severe endophthalmitis can occur after Xen® Gel Stent implantation. Patients with thin conjunctiva and/or cystic blebs over the stent should be followed particularly closely.

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Section: Discussionmentioning

confidence: 99%

Is the Xen® Gel Stent really minimally invasive?

Buffault

Baudouin

Labbé

2020

American Journal of Ophthalmology Case Reports

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“…5 However, only a few cases of endophthalmitis after Xen gel implantation has been reported in the literature, generally associated with the exposure of the device. 4,6,7 Given these data, the incidence of endophthalmitis after Xen gel surgery is actually unknown.…”

Section: Discussionmentioning

confidence: 99%

“…7 In other cases, however, Xen implant was left in place, and bleb reconstruction was performed. 6 Removal of an intraocular device as a source of contamination remains a debated topic, and no data are available for this kind of implant. Looking at other interventions, intraocular lens (IOL) removal in acute endophthalmitis following cataract surgery is generally not part of the initial management, while it should be considered in delayed-onset cases with recurrent or persistent infection.…”

Section: Discussionmentioning

confidence: 99%

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

Napoli¹,

Riva

Oddone

et al. 2019

European Journal of Ophthalmology

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Purpose: To describe the first case of endophthalmitis caused by Sphingobacterium spiritivorum, a glucose non-fermenting Gram-negative rod, in a patient previously implanted with a Xen® gel stent. Case report description: An 83-year-old patient, affected by open-angle glaucoma and with a previous surgery of combined cataract extraction and Xen gel stent implantation, developed endophthalmitis 1 month after bleb needle revision with 5-fluorouracil injection. At presentation, best corrected visual acuity was hand movement, hypopyon was evident into the anterior chamber and a flat bleb with no sign of leakage was present over the Xen gel implant. Outcome: Immediate pars plana vitrectomy was performed, with intravitreal antibiotic administration and silicon oil tamponade. S. spiritivorum was isolated from vitreous bacterial culture. According to the antibiogram, patient was treated with topical fortified ceftazidime eyedrops and appropriate systemic antibiotics (intravenous meropenem, 500 mg every 8 h for 7 days, followed by oral cotrimoxazole, 160 + 800 mg, twice a day for 10 days). After 2 weeks of treatment, ocular inflammation was resolved, best corrected visual acuity was 0.1 (Snellen chart) and intraocular pressure was 18 mm Hg without topical hypotensive therapy. Conclusion: S. spiritivorum was isolated for the first time as a causative agent of endophthalmitis in humans. Bleb needle revision in patients with Xen gel implant is not free of complications, and an attentive follow-up is required.

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“…If a patient presents with an avascular bleb but with good IOP control and no leakage, they can be carefully monitored. Topical lubricants and artificial tears should be used, especially if the patient is experiencing discomfort or ocular surface abnormalities [23]. A short course of steroids (e.g.…”

Section: Management Recommendationsmentioning

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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Ab Interno Gel Implant–associated Bleb-related Infection

Cited by 22 publications

References 9 publications

Is the Xen® Gel Stent really minimally invasive?

Is the Xen® Gel Stent really minimally invasive?

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

Navigating Challenges after Xen

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Ab Interno Gel Implant–associated Bleb-related Infection

Cited by 22 publications

References 9 publications

Is the Xen® Gel Stent really minimally invasive?

Is the Xen® Gel Stent really minimally invasive?

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

Navigating Challenges after Xen

Contact Info

Product

Resources

About

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