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

Sekaran, Anisha; Karimi, Ayesha; Lindfield, Dan

doi:10.1111/ceo.13335

Cited by 7 publications

(3 citation statements)

References 5 publications

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“…However, this procedure was accompanied by a trabeculectomy and the externalized part of the Xen implant was partially truncated during the dissection. Another report by Sekaran et al 5 presented a “redirect” revision technique which includes open revision, anchoring of the tip of the Xen implant, bleb compression sutures, and use of tissue adhesive and subconjunctival 5-fluorouracil.…”

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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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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“…Opening the conjunctiva 134 and primary needling 131 are some strategies. Stent exposure, [137][138][139] hypertrophic blebs, 140,141 ostium occlusion, 142 suprachoroidal haemorrhage 143 and endophthalmitis [144][145][146][147] have all been reported.…”

Section: Ab Externo Suprachoroidal Drainagementioning

confidence: 99%

The surgical management of glaucoma: A review

Lim

2022

Clinical Exper Ophthalmology

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After a long period of little change, glaucoma surgery has experienced a dramatic rise in the number of possible procedures in the last two decades. Glaucoma filtering surgeries with mitomycin C and glaucoma drainage devices remain the standard of surgical care. Other newer surgeries, some of which are minimally or microinvasive glaucoma surgeries, target existing trabecular outflow, enhance suprachoroidal outflow, create subconjunctival blebs, or reduce aqueous production. Some require the implantation of a device such as the iStent, Hydrus, Ex-PRESS, XEN and PRESERFLO, whilst others do not-Trabectome, Kahook dual blade, Ab interno canaloplasty, gonioscopy-assisted transluminal trabeculotomy, OMNI and excimer laser trabeculotomy. Others are a less destructive variation of an established procedure, such as micropulse transscleral cyclophotocoagulation, endoscopic cyclophotocoagulation and ultrasound cycloplasty. Cataract surgery alone can be a significant glaucoma operation. These older and newer glaucoma surgeries, their mechanism of action, efficacy and complications are the subject of this review.

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“…Symptoms may include ocular pain, discomfort, burning, foreign body sensation, and tearing [19]. Bleb dysesthesia may also interfere with lid closure, prohibiting proper tear film distribution and thus may cause surface irregularities including desiccation, epithelial defects, and dellen formation [20].…”

Section: Prominent And/or Nasal Blebsmentioning

confidence: 99%

Navigating Challenges after Xen

Vera¹,

Shah

Smith

et al. 2021

CTOY

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The XEN Gel Stent is a surgical implant for the treatment of glaucoma unresponsive to maximum tolerated medical therapy, with higher predictability and fewer sight-threatening complications than trabeculectomy or tube shunts. While complications following XEN implantation may be less common than in other glaucoma procedures, they are not completely avoidable. This paper elaborates the most commonly reported complications following XEN implantation with an aim to mitigate their occurrence by understanding the pathophysiology behind them. In addition, the authors provide insights from the literature and their own experience and make recommendations for management when complications do occur.

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

Cited by 7 publications

References 5 publications

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

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

The surgical management of glaucoma: A review

Navigating Challenges after Xen

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