“Dry Lake” technique for the treatment of hypertrophic bleb following XEN® Gel Stent placement

Fernández-García, A.; Juliá-Romero, Celia; Garzón, Nuria

doi:10.1016/j.oftale.2015.08.018

Cited by 10 publications

(7 citation statements)

References 7 publications

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“…A unique feature of Xen is 'shrink wrapping' of the implant by conjunctiva which needs to be prevented; therefore, any flattening of the bleb at the exit site or encapsulating of the bleb warrants further treatment. Theoretically, once the bleb has matured and subconjunctival fibrosis occurred, the resultant IOP may be limited by subconjunctival resistance -therefore close monitoring and a low threshold for early intervention of a hyperaemic or encapsulated bleb is likely to result in lesser fibrosis and better outcomes for the patient [9,23]. We introduce describing bleb management as: Pharmacological management of the bleb: involving injection of an antimetabolite or steroid into the bleb to prevent scarring.…”

Section: Postoperative Bleb Managementmentioning

confidence: 99%

A multi-centre interventional case series of 259 ab-interno Xen gel implants for glaucoma, with and without combined cataract surgery

Karimi

Lindfield

Turnbull

et al. 2018

Eye

122

132

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Aims To assess the efficacy of Xen in reducing intraocular pressure (IOP) in varying glaucoma subtypes. To assess the effect of combined phacoemulsification. To determine the frequency of complications and explore further bleb management needed. Methods Retrospective case note review of all patients undergoing Xen implantation across four centres from August 2015 to May 2017. Results In total, 259 consecutive surgeries of 226 patients were reviewed. IOP reduced from 19.3 (SD ± 6.0) mmHg preoperatively to 14.2 (SD ± 4.4) at month 12 and 13.5 (SD ± 3.3) at month 18 (p < 0.0001). Medication usage reduced from 2.6 (±1.1) preoperatively to 0.8 (±1.0) at month 12 (p < 0.0001) and 1.1 (±1.3) medications at month 18 (p < 0.0001). Simultaneous phacoemulsification did not alter outcomes as Xen IOP was 14.3 (SD ± 4.7) mmHg and Phaco-Xen was 13.8 (SD ± 2.6) mmHg at month 12 (p = 0.5367). Xen appears to be effective in previous failed filtration surgery. Adverse events included: IOP spikes of ≥30 mmHg in 33 (12.7%) cases, secondary filtration surgery required in 24 (9.3%) cases; implant exposure in 6 (2.3%) cases; persistent hypotonous maculopathy in 5 (1.9%) cases; persistent choroidal effusions in 4 (1.5%) cases; a cyclodialysis cleft secondary to implant insertion in 1 (0.5%) case; and 1 (0.5%) case of endophthalmitis postimplant bleb resuturing. In all, 40.9% of cases required postoperative bleb needling or antimetabolite injection. Conclusions Xen reduces IOP and medications at 18 months. Adverse events are uncommon. Careful postoperative surveillance and low threshold for bleb management is needed. Xen is safe and effective in mild to moderate glaucoma.

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Section: Postoperative Bleb Managementmentioning

confidence: 99%

A multi-centre interventional case series of 259 ab-interno Xen gel implants for glaucoma, with and without combined cataract surgery

Karimi

Lindfield

Turnbull

et al. 2018

Eye

122

132

View full text Add to dashboard Cite

show abstract

“…Proposals for surgical treatment include single case reports using transconjunctival sutures to compress the bleb or to create scar tissue on both sides of the Xen implant. 1,2 In addition, Fernández-García et al 3 reported the successful treatment of one eye with a hypertrophic bleb by blocking the ab interno Xen tube with viscoelastic and sealing the bleb with a tissue adhesive. However, such “suture techniques” may not be the best option if an immediate decrease in the bleb is needed due to corneal complications as with the present patient.…”

Section: Discussionmentioning

confidence: 99%

A novel surgical technique for the treatment of a filtration bleb extending over 180° after Xen gel stent implantation

Välimäki¹

2020

European Journal of Ophthalmology

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Purpose: To describe a novel surgical treatment option for managing a symptomatic filtration bleb extending into the three quadrants with adequate IOP control after Xen gel stent implantation. Methods: A 62-year-old female with pseudoexfoliative glaucoma with an IOP of 34 mmHg underwent implantation of a Xen to reduce the IOP in her right eye. The IOP responded well to the procedure, but the patient developed a persistent giant filtration bleb with foreign body sensation and pain. A huge filtering bleb of over 180° after Xen implant surgery was managed by splitting the giant bleb into two parts, posterior dissection into the intermuscular space, a biodegradable collagen device implantation, and suturing the conjunctiva in two parts with absorbable and nonabsorbable sutures. Results: Before the operation for treatment of a giant bleb, the patient had an IOP of 12 mmHg, a best-corrected visual acuity (BCVA) of 20/40, corneal dellen, and no antiglaucoma medication. Following the bleb recession procedure, the IOP was 16 mmHg, BCVA improved to 20/20, there were no corneal dellen and the patient reported resolution of her bleb discomfort. The IOP and BCVA remained stable through 18 months of follow-up and no antiglaucoma medications or additional surgical procedures were required. Conclusion: The novel technique described here can be one option to treat this rare (over 180°) bleb formation after Xen Gel Stent implantation without adversely affecting IOP control.

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“…Hypertrophic blebs have been described previously following Xen stent insertion and can lead to a mechanical ectropion, patient discomfort, Dellen formation and reduced visual acuity. MIGS devices may be associated with a more favourable risk profile to trabeculectomy.…”

mentioning

confidence: 99%

“…Retrospective analyses suggest that the ab‐interno stent is an effective minimally invasive glaucoma surgery (MIGS) device and may have lower rates of visually threatening complications compared to trabeculectomy . However, there have been reports of large dysaesthetic, hypertrophic or ‘mega’ blebs (Fig. ).…”

mentioning

confidence: 99%

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Hypertrophic dysaesthetic blebs following ab‐interno gel stent (Xen) glaucoma surgery: management and ‘redirect’ revision surgery

Sekaran

Karimi

Lindfield

2018

Clinical Exper Ophthalmology

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“Dry Lake” technique for the treatment of hypertrophic bleb following XEN® Gel Stent placement

Cited by 10 publications

References 7 publications

A multi-centre interventional case series of 259 ab-interno Xen gel implants for glaucoma, with and without combined cataract surgery

A multi-centre interventional case series of 259 ab-interno Xen gel implants for glaucoma, with and without combined cataract surgery

A novel surgical technique for the treatment of a filtration bleb extending over 180° after Xen gel stent implantation

Hypertrophic dysaesthetic blebs following ab‐interno gel stent (Xen) glaucoma surgery: management and ‘redirect’ revision surgery

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