Managing Drawbacks in Unconventional Successful Glaucoma Surgery: A Case Report of Stent Exposure

Abstract

Traditional options in managing failed trabeculectomy (bleb needling, revision, additional incisional surgery and tube surgery) have a relatively high failure and complication rate. The use of microinvasive glaucoma surgery (MIGS) has generally been reserved to mild to moderate glaucoma cases, proving good safety profiles but significant limitations in terms of efficacy. We describe a patient who underwent MIGS (XEN Aquesys subconjunctival shunt implantation) after a prior failed trabeculectomy. After the surgery, the IOP was well controlled but as the stent was close to an area of scarred conjunctiva of the previous trabeculectomy, it became partially exposed. As a complete success was achieved, we decided to remove the conjunctiva over the exposed area and replace it by an amniotic membrane transplantation and a conjunctiva autograft. Six months after surgery, the unmedicated IOP is still well controlled with complete visual acuity recovery.

XEN‐45 collagen implant for the treatment of uveitic glaucoma

“…Three eyes (12.5%) lost ≥2 lines of BCVA due to cataract progression after XEN‐45 stent implantation, likely secondary to the use of postoperative steroid eye drops. Despite the material of the XEN‐45 implant being soft and tissue‐conforming, implant exposure occurred in two eyes (8.3%) in our study and has also been reported previously …”

“…Despite the material of the XEN-45 implant being soft and tissue-conforming, implant exposure occurred in two eyes (8.3%) in our study and has also been reported previously. 25,28,29 Our study was limited by the small number of patients. There was insufficient statistical power to identify the predictors of failure.…”

XEN Gel Stent in the management of primary open-angle glaucoma

“…Since then, several studies have been carried out to assess the efficacy of the XEN-GGM. Most of them (including our study) focus on IOP reduction, the number of anti-glaucoma medications and complications [7][8][9][10]. However, unlike other published studies, ours is the first to determine the transient pattern ERG trend after XEN-GGM execution.…”

“…Out of all MIGS procedures, only XEN Glaucoma Microstent (XEN-GGM, Allergan Plc, Parisppanny, NJ, USA) improves aqueous outflow by creating the subconjunctival outflow pathway. All other MIGS procedures improve the outflow via either Schlemm's canal or suprachoroidal pathway [7,8]. The XEN-GGM is a trans-scleral gel stent implanted through the clear corneal incision.…”

“…It provides drainage from the anterior chamber to the subconjunctival space. Some studies show that the efficacy of the XEN-GGM is comparable to the one of trabeculectomy with the former making it possible to avoid conjunctival incision and being associated with lower complication rates [7][8][9]. Currently, XEN-GGM is recommended as a stand-alone procedure or combined glaucoma and cataract surgery in patients with mildto-moderate glaucoma and unstable IOP despite medical therapy [10].…”