Endophthalmitis After XEN Gel Stent Implantation: 2 Cases

Abstract

Herein, we report 2 cases of endophthalmitis after XEN Gel Stent implantation. A 68-year-old woman and an 80-year-old man had previously undergone uncomplicated XEN Gel Stent implantation for primary open-angle glaucoma 4 and 5 months prior, respectively. Both patients had presented with pain, redness, loss of vision, and sensitivity to light. For both patients, the best-corrected visual acuity was hand motion, eyelids and conjunctiva were hyperemic and edematous, anterior chamber had +3 cells and exhibited hypopyon, and B-scan ultrasonography revealed vitreous condensation. Blebitis was absent; the bleb height was medium, bleb width was 1 to 2 hours, and the bleb was avascular in the first case. In the second case, ∼2 mm of the XEN Gel Stent implant protruded from the conjunctiva; therefore, bleb formation was not observed. On a previous visit, the bleb height was medium, bleb width was 2 to 3 hours, and the bleb was mildly vascular. Both patients had undergone vitrectomy with silicone oil injection, but only the female patient had received intravitreal and topical antibiotics preoperatively. After surgery, both patients received topical antibiotic therapy. After 2 to 3 months, the silicone oil was removed; the final visual acuity remained low for the female patient (hand motion level). Despite immediate treatment, the final visual acuity may remain poor, similar to the outcome of patients with other types of endophthalmitis. It is important to provide the patients scheduled for XEN Gel Stent implantation information on the risk of infection and the other risk factors involved.

Bilateral consecutive Xen gel stent surgery during pregnancy for uncontrolled early-onset primary open angle glaucoma

“…Given the reported relative safety of Xen gel stent in preventing early hypotony, 1 bilateral insertion may become possible for patients who require urgent IOP lowering in both eyes. However, Xen gel stent is not without its post-operative complications, as demonstrated in this case some patients require anterior chamber reformation for early anterior chamber shallowing, 11 and cases of endophthalmitis are being reported 12 , 13 . Therefore, authors still advise that for patients who require prompt bilateral surgical IOP lowering should still have consecutive surgery performed several days apart, depending on severity of glaucoma.…”

Is the Xen® Gel Stent really minimally invasive?

“…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.…”

Minimally invasive glaucoma surgery (MIGS): XEN implant

“…Obecnie uważa się, że implantacja XEN® jest procedurą obarczoną bardzo niewielkim odstetkiem powikłań. Opisywane są niewielkie krwawienia podspojówkowe i do komory przedniej oka, a spłycenie komory przedniej i hipotonia oczna czy odsłonięcie implantu, jaskra złośliwa oraz zapalenie wnętrza oka występują bardzo rzadko [5,10,14,15,[19][20][21][22]. Stosując opisaną metodę chirurgicznego leczenia jaskry, po roku obserwacji można uzyskać spadek ć.w.…”