Early postoperative lumen blockage of ab-interno gel stent (XEN) cleared with Nd:YAG laser

Scantling‐Birch, Yarrow; Merzougui, Wassim; Lindfield, Dan

doi:10.4103/ijo.ijo_1051_19

Cited by 13 publications

(18 citation statements)

References 2 publications

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“…In der Literatur ist die Bildung von Fibrin nach kombinierter Kataraktoperation und MIGS vorbeschrieben: So kam es am ersten postoperativen Tag bei einer 72-jährigen Patientin zu einer Okklusion des Shunt-Lumens, die erfolgreich mittels Nd:YAG-Laser behandelt wurde [ 5 ]. Infolge dieser Beobachtungen wird nach MIGS, insbesondere nach kombinierter Operation, zu einer intensiven topischen antiinflammatorischen Therapie geraten [ 9 ].…”

Section: Diskussionunclassified

Trübung der Intraokularlinse nach kombinierter Katarakt- und minimal-invasiver Glaukomchirurgie (MIGS)

2020

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ZusammenfassungDrei Wochen nach komplikationsloser kombinierter minimal-invasiver Glaukom- und Kataraktoperation kam es zu einer Sehverschlechterung durch die Eintrübung der Intraokularlinse. Durch die Nichtanwendung der postoperativen antiinflammatorischen Lokaltherapie kam es zu einer homogenen Fibrinbildung auf der Linsenvorderfläche sowie einer beginnenden Vernarbung des Sickerkissens. Wir führten ein Needling mit 5‑Fluorouracil sowie eine Linsenpolitur mit dem Nd:YAG-Laser durch und erreichten so eine suffiziente Druckkontrolle und Sehverbesserung.

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Section: Diskussionunclassified

Trübung der Intraokularlinse nach kombinierter Katarakt- und minimal-invasiver Glaukomchirurgie (MIGS)

2020

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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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“…The XEN gel stent (Allergan Plc, Dublin, Ireland), developed using biocompatible hydrophilic material, has been spotlighted as a device that can be surgically implanted to effectively control intraocular pressure (IOP) with fewer and less severe postoperative complications compared with conventional glaucoma filtering surgery [ 1 ]. However, within a week of XEN gel stent implantation, about 4% of patients experience early-postoperative lumen blockage by blood clot, iris pigment or fibrin [ 2 ]. Also, late obstruction can be caused by chronic intraocular inflammation [ 3 ].…”

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confidence: 99%

“…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 ]. reported lumen blockage that was cleared by Nd: YAG laser ablation.…”

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confidence: 99%

“…What should be highlighted in this case is the fact that the Nd: YAG laser can be used to resolve lumen blockage by iris pigment after XEN gel stent implantation. Although there is a case wherein a fibrin-blocked lumen after XEN gel stent implantation was reopened with the Nd: YAG laser [ 2 ], there are as yet no reports of Nd: YAG laser reopening of lumens blocked with iris pigment. Using less-invasive Nd: YAG laser ablation to recanalize the obstructed lumen could reduce the potential risk of surgical complication while preserving the XEN gel stent.…”

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confidence: 99%

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

Kim

Lee

2021

Korean J Ophthalmol

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Early postoperative lumen blockage of ab-interno gel stent (XEN) cleared with Nd:YAG laser

Cited by 13 publications

References 2 publications

Trübung der Intraokularlinse nach kombinierter Katarakt- und minimal-invasiver Glaukomchirurgie (MIGS)

Trübung der Intraokularlinse nach kombinierter Katarakt- und minimal-invasiver Glaukomchirurgie (MIGS)

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

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

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