Xen Gel Stent as a minimally invasive option for intraocular pressure control after DSAEK: A case study

Abstract

Purpose: This case study describes the implantation of a Xen45 Gel Stent in a patient that had previously undergone Descemet stripping automated endothelial keratoplasty (DSAEK). Glaucoma might worsen after corneal transplant, and while medical treatment is the first-line therapy to achieve intraocular pressure (IOP) control, a surgical approach is required when medication does not reach the target IOP. Methods: In 2017, the patient underwent treatment in both eyes with ocular hypotensive eye drops for pseudoexfoliative (PXF) glaucoma. In May 2017, DSAEK was performed on the right eye because of the presence of a pseudophakic bullous keratopathy. An increase in IOP, resistant to medical treatment, was observed after the corneal transplant. In November 2017, a Xen45 Gel Stent was implanted. Results: The patient had a positive outcome with a Xen45 Gel Stent implant in surgical glaucoma treatment after DSAEK. The case demonstrated excellent postoperative IOP control, stable vision and a healthy ocular graft at short-term and long-term follow-ups. Conclusion: Studies with larger numbers of patients in this particular form of therapy are required. Nevertheless, Xen45 Gel Stent implantation appears to be a promising option in preventing or limiting glaucoma in patients who have previously undergone DSAEK. It is a brief, minimally invasive procedure with reduced postoperative inflammation, faster visual recovery and a lower risk of graft damage or hypotony, even in the case of PXF glaucoma.

Clinical Outcomes in Maximum Tolerated Medical Therapy in Penetrating Keratoplasty for Bullous Keratopathy

“…As for the Ex-Press mini-shunt (Alcon Laboratories), endothelial cell loss at 12 months was 10.0% and at 24 months was 18.0% in long-term studies ( 39 , 40 ). There are only several case reports describing the effects of MIGS on corneal endothelial cells in post-keratoplasty glaucoma so far, and the results are controversial ( 41 , 42 ).…”

Glaucoma in Patients With Endothelial Keratoplasty

“…Very few studies have assessed the efficacy of MIGS in this patient population; however, preliminary studies suggest varying degrees of success. 123,124 Finally, cyclodestructive procedures such as transscleral diode laser photocoagulation are nonincisional options that have been used in refractory glaucoma after PK. 125 However, these procedures can be associated with postoperative inflammation leading to hypotony, graft rejection, and phthisis bulbi in PK patients.…”