Subconjunctival Fragmentation of a Previously Efficient XEN Gel Stent Implantation and Successful Bleb Formation: a Case Report

Abstract

The XEN gel stent is one of the available minimally invasive glaucoma surgery devices, a new generation implant, which is designed to reduce intraocular pressure in patients with primary open angle glaucoma if past medical treatments have failed. This report presents a case of subconjunctival fragmentation of the XEN gel stent after a three-month follow-up of successful XEN gel implantation. A 70-year-old male patient was treated for primary open angle glaucoma. He underwent successful phacoemulsification and intraocular lens implantation two years before. Due to medical therapy failure in controlling glaucoma, XEN gel stent implantation was suggested to the patient. The implant was successfully placed in both eyes, and extended bleb and drainage aqueous humor from the anterior chamber to the subconjunctival space was obtained. Three months after the surgery, at a regular follow-up visit, three fragments of the subconjunctival part of the XEN gel implant were found in his left eye. Neither serious complications nor intraocular pressure increase were detected. A new potential complication of the XEN gel implant is described.

Complications of XEN gel stent implantation for the treatment of glaucoma: a systematic review

“…However, there have been reports of breakage and fragmentation of the subconjunctival part when the surgeon attempted to relocate the stent using forceps ( 105 ). Novak-Laus et al also reported a case of “spontaneous” fragmentation of the subconjunctival part of the XEN gel stent discovered during a regular follow-up visit 3 months after surgery in a patient who denied rubbing their eye or experiencing any incidental trauma that could explain the breakage ( 81 ). Despite the fragmentation of the stent, it was not replaced because the distal end remained in the Schlemm’s canal and the patient maintained normal IOP ( 81 ).…”

“…Novak-Laus et al also reported a case of “spontaneous” fragmentation of the subconjunctival part of the XEN gel stent discovered during a regular follow-up visit 3 months after surgery in a patient who denied rubbing their eye or experiencing any incidental trauma that could explain the breakage ( 81 ). Despite the fragmentation of the stent, it was not replaced because the distal end remained in the Schlemm’s canal and the patient maintained normal IOP ( 81 ). Bustros et al reported a case where a fragment of the XEN gel implant was inadvertently damaged during the needling procedure, 2 months postoperatively.…”