Rescue of Xen45 Gel Stent Implant Occlusion In Refractory Glaucoma: A Case Report

Abstract

Background Xen Gel Stent implant is a new minimally invasive surgical treatment for glaucoma that has been proven effectiveness and safety profile. However, it may also lead to some complications. Xen Gel Stent occlusion is a relatively rare complication reported less frequently and has limited treatment experience. In our case report, we proposed a novel surgical treatment using a 10 − 0 nylon suture to recanalize the occluded Xen45 Gel Stent successfully. Case presentation: A 16-year-old female patient had bilateral juvenile glaucoma for the past 5 years. Her right eye had undergone three glaucoma surgeries but failed. At a presentation to our hospital, the intraocular pressure (IOP) in the right eye was 30 mmHg despite the application of four topical eye drops. Xen45 Gel Stent implant was chosen for treatment, but six days after implantation, the IOP rose to 40 mmHg due to an occlusion of the tip of Xen45 Gel Stent in the anterior chamber. Nd: YAG laser shockwave therapy was attempted but failed. The patient eventually had to return to the operating room for a revision procedure. A 10 − 0 nylon suture was threaded through the Xen45 Gel Stent to recanalize it. The IOP was successfully controlled in the 11-month follow-up. Conclusion If postoperative occlusion arises after Xen45 Gel Stent implantation, surgery using 10 − 0 nylon suture to recanalize Xen45 Gel Stent should be considered as a relatively safe, effective, and minimally invasive alternative that does not require removal or trimming of Xen45 Gel Stent.