Possible Intraluminal Obstruction of the XEN45 Gel Stent Observed With Anterior Segment Optical Coherence Tomography

Rigo, Jaume; Castany, Marta; Banderas, Sandra; Pujol, Olivia; Amilburu, Manuel; Dou, Antoni

doi:10.1097/ijg.0000000000001351

Cited by 11 publications

(15 citation statements)

References 11 publications

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“…Intraluminal debris that is difficult to see with the slit-lamp has been documented in the XEN-45 gel stent with AS-OCT, which correlates well with our clinical findings. 13 …”

Section: Discussionmentioning

confidence: 99%

Rescue of Failed XEN-45 Gel Implant by Nd:YAG Shock Wave to Anterior Chamber Tip to Dislodge Hidden Intraluminal Occlusion

Fellman

Grover²,

Smith³

et al. 2021

Journal of Glaucoma

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Purpose: The purpose of this study was to inform ophthalmic surgeons in a timely manner of the hidden problem of clear intraluminal cellular debris as a cause for XEN-45 failure and to describe low energy neodymium-doped yttrium aluminum garnet (Nd:YAG) laser revision with periluminal anterior chamber tip shockwave treatment to improve flow to the bleb. Patients and Methods: Six patients with visibly patent stent lumen post XEN-45 surgery. These eyes developed rising intraocular pressure (IOP) with a history of excellent prior bleb formation and were treated successfully with Nd:YAG laser shockwave therapy to disperse assumed intraluminal cellular debris. The laser was aimed just anterior and axial to the intracameral tip of the gel stent through a gonioscopy lens. Results: Six patients with an average age of 75 years (60 to 90 y), preoperative IOP of 30 mm Hg (16 to 52 mm Hg) on an average of 2 antiglaucoma medications (0 to 4) underwent periluminal anterior chamber tip shock wave at an average of 12 months (1 to 38 mo) from XEN-45 surgery. The IOP was immediately reduced to an average of 15 mm Hg (8 to 23 mm Hg) and last IOP averaged 15 mm Hg (10 to 23 mm Hg) on 1.5 medications (0 to 4) at 4 months post periluminal anterior chamber tip shock wave. Conclusion: Nd:YAG laser revision of hidden blockage of a XEN-45 gel implant with periluminal anterior chamber tip shockwave treatment can disperse invisible intraluminal cellular debris and improve flow in a failing XEN-45 microstent, especially when distal fibrosis is not excessive.

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“…Intraluminal debris that is difficult to see with the slit-lamp has been documented in the XEN-45 gel stent with AS-OCT, which correlates well with our clinical findings. 13 …”

Section: Discussionmentioning

confidence: 99%

Rescue of Failed XEN-45 Gel Implant by Nd:YAG Shock Wave to Anterior Chamber Tip to Dislodge Hidden Intraluminal Occlusion

Fellman

Grover²,

Smith³

et al. 2021

Journal of Glaucoma

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“…Rigo 58 reported the OCT findings of 46 eyes (39 patients) retrospectively evaluated 6 months or more after an uneventful Xen. Possible intraluminal obstructions evidenced by hyper-reflective material on OCT were identified in 16 eyes (15 POAG eyes and 1 PXG) with unremarkable slit-lamp exams in.…”

Section: Intraluminal Obstructionmentioning

confidence: 99%

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

Fea¹,

Durr²,

Marolo³

et al. 2020

OPTH

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The XEN Gel Microstent is a subconjunctival microinvasive glaucoma surgical device developed with the aim of improving the predictability and safety profile of blebforming glaucoma surgical procedures. The stent is a hydrophilic tube composed of a porcine gel cross-linked with glutaraldehyde with good stability and biocompatibility with minimal tissue reaction. This device has demonstrated promising outcomes with fewer risks compared to traditional surgeries. The aim of the review is to present early studies on different designs of the XEN Gel Stent, to summarize different surgical techniques of implantation and to analyze more comprehensively the results, complications and rates of needling of the commercially available device (Xen 45). The review will address separately special cases (PXG, UVG, ICE, congenital glaucoma) and describe small series and case reports.

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“…26 We hypothesize that phacoemulsification-derived particles may enhance bleb inflammation and scarring, as described in other filtering procedures. 27 Additionally, intraluminal organic material obstructing glaucoma implants has been found in combined Phaco-Express P50 procedures in which SBR was unsuccessful. 26 Anterior segment optical coherence tomography has illustrated similar intraluminal obstruction in cases with prior combined phaco-XEN surgery and signs of a flat, nonfunctional bleb.…”

Section: Discussionmentioning

confidence: 99%

“…26 Anterior segment optical coherence tomography has illustrated similar intraluminal obstruction in cases with prior combined phaco-XEN surgery and signs of a flat, nonfunctional bleb. 27 Further studies including systematic anterior segment bleb and stent imaging are needed to validate these hypotheses.…”

Section: Discussionmentioning

confidence: 99%

XEN45 real-life evaluation: Survival analysis with bleb needling and major revision outcomes

Ventura-Abreu

Dotti-Boada

Muniesa-Royo

et al. 2021

European Journal of Ophthalmology

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Purpose: To evaluate real-life outcomes of XEN45 stent surgery including bleb needling (BN) and surgical bleb revision (SBR). Methods: Retrospective analysis of all XEN45 gel stents implanted in a tertiary glaucoma center with a minimum follow-up of 6 months. The main outcomes were intraocular pressure (IOP), the number of glaucoma medications, postoperative maneuvers like BN, and subsequent SBR. Success was defined as IOP ⩽ 18 and 20% reduction (criterion A), ⩽15 and 25% reduction (criterion B), and ⩽12 mmHg and 30% reduction (criterion C) reached with (qualified) or without (complete) medications at the last visit. Complete failure was defined as additional glaucoma surgery, loss of light perception, or sight-threatening complications. Multivariable Cox regression and Kaplan-Meier survival estimates tests were performed. Results: Fifty-eight eyes with either stand-alone or combined Phaco-XEN surgery were included. Complete success by the different definitions was 50.0% (95% confidence interval, 5.8%–84.5%) (A), 50.0% (5.8%–84.5%) (B), and 25% (0.9%–66.5%) (C) whereas qualified success was 38.3% (1.6%–80.1%), 31.7% (2.0%–71.4%), and 0%, respectively, at the 24-months visit. 30% of cases underwent BN with 5-Fluorouracil, and SBR was performed in 17.5% of eyes. Low IOP levels at 1-month and early BN were significantly associated with success. The highest chance of failure was achieved in the combined Phaco-XEN group undergoing SBR. Conclusions: In our real-life setting, the first month IOP was associated with greater success rates. Although BN obtained improved IOP values, SBR was associated with a greater bleb survival in the stand-alone XEN group. Both BN and SBR had poor outcomes in the combined Phaco-XEN group.

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Possible Intraluminal Obstruction of the XEN45 Gel Stent Observed With Anterior Segment Optical Coherence Tomography

Cited by 11 publications

References 11 publications

Rescue of Failed XEN-45 Gel Implant by Nd:YAG Shock Wave to Anterior Chamber Tip to Dislodge Hidden Intraluminal Occlusion

Rescue of Failed XEN-45 Gel Implant by Nd:YAG Shock Wave to Anterior Chamber Tip to Dislodge Hidden Intraluminal Occlusion

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

XEN45 real-life evaluation: Survival analysis with bleb needling and major revision outcomes

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