Intraocular Degradation of XEN45 Gel Stent 3 Years After its Implantation

Abstract

Introduction: We report a case of XEN45 Gel Stent removal 3 years after its implantation. The stent had degraded with a closed lumen, so a new stent was implanted. Case Report: A 63-year-old woman was scheduled for XEN45 Gel Stent implantation. Three years after the primary surgery and 2 years after a surgical revision, second revision surgery was required. The conjunctiva was opened, and the implanted XEN Gel Stent was stripped of the adhesive scar tissues. No aqueous humor flow was seen through the stent, and therefore, the stent was removed. The intrascleral and intracameral parts had degraded. The surface of the stent was irregular and cobbled. A part of the lumen in the middle of the stent had closed. Discussion: We detected changes in the stent after its removal during the surgical revision with conjunctival opening, which is our standard approach for failed XEN Gel Stents. Most surgeons advise needling of the stent in cases of failure. However, in cases of needling, changes in the stent might not have been detected. Thus, the number of patients with similar changes as this report might be higher than the publications suggest. No unique characteristics distinguished this patient from those who had a functional XEN Gel Stent. The stent, in this case, might have been of inferior quality as an exception, or all stents might degrade over time. Therefore, gonioscopy should be performed carefully to detect any changes in the stent. In cases of suspected stent degradation, we recommend a revision surgery with conjunctival opening and removal of the stent in cases of degradation.

XEN® Gel Stent compared to PRESERFLO™ MicroShunt implantation for primary open‐angle glaucoma: two‐year results

“…Thirdly, the material and design of the two implants differ, which may possibly have different effects on biocompatibility, foreign‐body reaction and migration after implantation. Widder et al (2019) recently published a case report of stent degradation after Xen implantation. The long‐term effect of these materials in glaucoma patients is yet to be established.…”

Comparing Medium-Term Clinical Outcomes following XEN® 45 and XEN® 63 Device Implantation

“…Other complications that have been reported in the context of XEN ® 45 implantation procedures were device fracture during needling [20], endophthalmitis [21], or degradation of the device [22], but we are happy to report that none of them occurred in our case series, nor was there any procedural failure (defined as presence of a secondary IOP lowering procedure or loss of light perception) [18] during the three-year follow-up period that made it necessary to replace the gel stent. Comparing our outcomes with other studies found in the literature, De Gregorio [16] (XEN ® 63 implantation procedures) reported an 11.8% failure rate, whereas Lenzhofer had 10% of failed XEN ® 63 implantation surgeries [18].…”

<p>XEN^® Gel Stent: A Comprehensive Review on Its Use as a Treatment Option for Refractory Glaucoma</p>

“…Widder et al 61 presented a 63-year-old woman with Xen implant requiring revision 3 years after surgery after having had two failed previous revision. At the time of revision, the conjunctiva was opened and the implant was stripped of the adhesive scar tissues.…”