Xen gel stent occlusion with iris pigment epithelium

Eagle, Ralph C.; Razeghinejad, Reza

doi:10.1111/ceo.13658

Cited by 7 publications

(17 citation statements)

References 3 publications

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“…There are several previous reports of XEN gel stent lumen blockage. Eagle and Razeghinejad reported proximal-end obstruction by iris pigment, similarly to the current report, but theirs was an instance of early-postoperative obstruction (7 days) in a primary open-angle glaucoma patient for whom the stent was removed surgically [4]. Scantling-Birch et al [2].…”

Section: Use Of Nd: Yag Laser To Recanalize Xen Gel Stent Occluded By Iris Pigmentsupporting

confidence: 78%

Use of Nd: YAG Laser to Recanalize XEN Gel Stent Occluded by Iris Pigment

Kim

Lee

2021

Korean J Ophthalmol

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Section: Use Of Nd: Yag Laser To Recanalize Xen Gel Stent Occluded By Iris Pigmentsupporting

confidence: 78%

Use of Nd: YAG Laser to Recanalize XEN Gel Stent Occluded by Iris Pigment

Kim

Lee

2021

Korean J Ophthalmol

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“…[ 4 , 5 ] Because of the small internal lumen (45 μm), reports have previously indicated that XEN occlusion can occur due to fibrin, blood clots, or the iris. [ 6 – 10 ]…”

Section: Discussionmentioning

confidence: 99%

Recanalization of XEN-45 gel stent occlusion with cortical material after phaco-XEN surgery using Nd: YAG laser treatment

Seo

Lim

2021

Medicine

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Introduction: The XEN Gel Stent (Allergan Inc., CA, USA) has been widely used in minimally invasive glaucoma surgery to lower intraocular pressure considering reasonable efficacy and safety profiles. However, the XEN gel stent could be occluded by fibrin, blood clots, or the iris due to its small lumen design for preventing postoperative hypotony. To date, only a few studies have assessed XEN occlusion after combined phacoemulsification with XEN gel implantation and how to manage this condition. We describe the first case report of XEN gel stent obstruction by cortical material, demonstrated by anterior segment optical coherence tomography (AS-OCT), which resolved effectively after low-energy neodymium-doped yttrium aluminum garnet (Nd: YAG) laser shock wave treatment. Patient Information: A 76-year-old Korean male patient underwent uncomplicated phaco-XEN-gel stent implantation and presented with low intraocular pressure (IOP) with a well-functioning filtering bleb during the first postoperative 4 days. On postoperative day 5, the XEN lumen was occluded by the cortical material, with an intraocular pressure elevation of 28 mm Hg. Slit-lamp examination revealed that cortical material was causing a block into the internal ostium of the XEN gel implant. AS-OCT examination also demonstrated the presence of hyper-reflective materials at the intraluminal portion and peritubular portion around the internal ostium of the XEN gel implant. Diagnosis: XEN gel stent occlusion with cortical material after Phaco-XEN surgery. Interventions: Low-energy Nd: YAG laser shock wave treatment. Outcomes: The IOP dropped from 28 mm Hg to 8 mm Hg immediately after treatment. Transient hypotony and a slightly shallow anterior chamber were noted over the 3 days after YAG laser treatment. The IOP continued to be well-controlled until 3 months later (range; 6 - 12 mm Hg). Conclusions: To the best of our knowledge, this is the first case report on the efficacy of Nd: YAG laser treatment for recanalization of XEN implant occluded by the cortex. Moreover, AS-OCT could provide additional clinical information for recanalization of the XEN gel stent.

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“…[5] In addition, Scantling-Birch et al suggested that YAG-laser fibrinolysis could lead to successful clearing of lumen obstructions. [11] On the basis of these previous reports, [5,11] we also performed the peri-lumen Nd: YAG shock wave treatment for re-canalization. As a result, we were able to re-establish the flow of the iris-occluded XEN implant with this combined laser treatment.…”

Section: Discussionmentioning

confidence: 99%

“…In these contexts, Sng et al estimated a 3.2% risk of developing XEN stent iris occlusion [9] . However, there are limited reports of XEN iris occlusion and its management in the literature [5,8] …”

Section: Discussionmentioning

confidence: 99%

“…To date, few studies have explored XEN-iris occlusion and how it should be managed [5,8] . Herein, we describe the first case report of a recurrent XEN gel stent obstruction by a “plug” shaped iris incarceration, which effectively resolved after combined treatment with argon laser peripheral iridoplasty (ALPI) and low energy neodymium-doped yttrium aluminum garnet (Nd: YAG) laser shock wave treatment.…”

Section: Introductionmentioning

confidence: 99%

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Combined argon laser peripheral iridoplasty and Nd: YAG laser shock wave therapy for recurrent XEN gel stent obstruction due to iris incarceration

Rho

Lim

2021

Medicine

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Introduction: Despite its proven effectiveness and safety profile, the XEN Gel Stent (Allergan Inc., CA, USA) has a small lumen and is therefore likely to become occluded by fibrin, a blood clot, or even the iris. However, few studies have investigated XEN-iris occlusion and how to manage this condition. We describe the first case report of recurrent XEN gel stent obstruction by iris incarceration, which was resolved following a combined treatment with argon laser peripheral iridoplasty (ALPI) and low-energy neodymium-doped yttrium aluminum garnet (Nd: YAG) laser shock wave treatment.Patient information: A 74-year-old Korean male underwent uncomplicated XEN gel stent implantation and presented with low intraocular pressure (IOP) with a well-functioning filtering bleb during the first postoperative week. On postoperative day 10, the XEN lumen was occluded by the iris and demonstrated an IOP spike of 33 mmHg. Despite the use of pilocarpine, the iris incarceration persisted. Therefore, surgery to reposition the XEN stent was attempted using a gonio-prism and intraocular forceps. After the first revision surgery, the IOP and stent position were stable for 2 weeks. However, recurrent partial obstruction of the stent by the iris, pigment dispersion into the intraluminal space, and an elevated IOP of 24 mmHg were observed later.Diagnosis: Recurrent XEN gel stent occlusion by the iris and intraluminal pigment dispersion.Interventions: Combined ALPI and low energy Nd: YAG laser shock wave therapy.Outcomes: IOP dropped from 24 mmHg to 10 mmHg immediately and continued to be well-controlled until 3 months later (range: 8-12 mmHg).Conclusions: To the best of our knowledge, this is the first case report of the efficacy of combined laser treatment for relieving recurrent XEN implant occlusion by the iris. This combination laser treatment might be a relatively safe rescue treatment to restore the patency of a XEN gel stent occluded by the iris, even in cases with recurrent XEN stent obstruction after surgical repositioning.Abbreviations: AC = anterior chamber, ALPI = argon laser peripheral iridoplasty, AS-OCT = anterior segment optical coherence tomography, IOP = intraocular pressure, Nd: YAG = neodymium-doped yttrium aluminum garnet.

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Xen gel stent occlusion with iris pigment epithelium

Cited by 7 publications

References 3 publications

Use of Nd: YAG Laser to Recanalize XEN Gel Stent Occluded by Iris Pigment

Use of Nd: YAG Laser to Recanalize XEN Gel Stent Occluded by Iris Pigment

Recanalization of XEN-45 gel stent occlusion with cortical material after phaco-XEN surgery using Nd: YAG laser treatment

Combined argon laser peripheral iridoplasty and Nd: YAG laser shock wave therapy for recurrent XEN gel stent obstruction due to iris incarceration

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