XEN Gel Stent Early Failure-dye-enhanced Ab-externo Revision

Ferreira, Nuno Pinto; Pinto, Joana Medeiros; Teixeira, F.; Pinto, Luís Abegão

doi:10.5005/jp-journals-10078-1237

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…Ferreira et al 42 reported the first case where Xen early failure (IOP 26mmHg with a thickened non-diffuse bleb despite medical treatment) which was needled with trypan blue injected in the AC prior to the intervention. This case report highlights the advantages of injecting Trypan blue at the time of needling as it helps better assess when the flow is re-established.…”

Section: Efficacy and Safety Of Needling Revisionmentioning

confidence: 99%

XEN® Gel Stent: A Comprehensive Review on Its Use as a Treatment Option for Refractory Glaucoma

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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Section: Efficacy and Safety Of Needling Revisionmentioning

confidence: 99%

XEN® Gel Stent: A Comprehensive Review on Its Use as a Treatment Option for Refractory Glaucoma

Fea¹,

Durr²,

Marolo³

et al. 2020

OPTH

View full text Add to dashboard Cite

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“…In human patients, there are a handful of case reports showing bleb-related outflow pathways after tracer injection. 15 – 17 , 19 , 37 Better work has been performed in post-trabeculectomy patients who received intracameral trypan blue injection during cataract surgery showing that greater IOP reduction is seen when there are a greater number of observed pathways. 15 However, simultaneous structural evaluation in prior reports was absent.…”

Section: Discussionmentioning

confidence: 99%

Bleb-related Porcine Lymphatic Outflow Is Greater from Subconjunctival compared to Subtenon Blebs

Lee¹,

Strohmaier²,

Akiyama³

et al. 2023

Journal of Current Glaucoma Practice

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A bstract Aim Understanding the mechanism of fluid outflow by comparing the subconjunctival and subtenon spaces can lead to improved ocular therapeutics. The purpose of the current study is to evaluate subconjunctival vs subtenon lymphatic outflow by creating tracer-filled blebs in each location. Methods Porcine ( n = 20) eyes received subconjunctival or subtenon injection(s) of fixable and fluorescent dextrans. Blebs were angiographically imaged using a Heidelberg Spectralis ([Heidelberg Retina Angiograph] HRA + OCT; Heidelberg Engineering) and bleb-related lymphatic outflow pathways were counted. Optical coherence tomography (OCT) imaging of these pathways was used to assess structural lumens and the presence of valve-like structures. Furthermore, a comparison between tracer injection locations (superior/inferior/temporal/nasal) was made. Histologic analyses for subconjunctival and subtenon outflow pathways were performed, to confirm tracer co-localization with molecular lymphatic markers. Results Subconjunctival blebs demonstrated a greater number of lymphatic outflow pathways compared to subtenon blebs in every quadrant [superior: 6.10 ± 1.18 (subconjunctival) vs 0.50 ± 0.27 (subtenon); temporal: 2.30 ± 0.40 vs 0.10 ± 0.10; nasal: 5.30 ± 0.60 vs 0.30 ± 0.21; inferior: 6.00 ±1.29 vs 0.1 ± 0.1; all comparisons p < 0.001]. For subconjunctival blebs, the temporal quadrant showed fewer lymphatic outflow pathways compared to the nasal side ( p = 0.005). Discussion Subconjunctival blebs accessed greater lymphatic outflow compared to subtenon blebs. Furthermore, regional differences existed, with fewer lymphatic vessels temporal than at the other locations. Clinical significance Aqueous humor drainage after glaucoma surgery is incompletely understood. The present manuscript adds to our understanding of how lymphatics might influence filtration bleb function. How to cite this article Lee JY, Strohmaier CA, Akiyama G, et al. Bleb-related Porcine Lymphatic Outflow Is Greater from Subconjunctival compared to Subtenon Blebs. J Curr Glaucoma Pract 2022;16(3):144-151.

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“… 17 Besides its application in the initial surgery, it has also been described as assisting the needling technique for early bleb failure after XEN implantation. 18 Trypan blue is safe for both corneal and trabecular meshwork cells. 11 Moreover, surgeons are already familiar with its use and it is also readily available.…”

Section: Discussionmentioning

confidence: 99%

XEN Gel Staining with Trypan Blue: A Simple and Effective Technique to Improve Device Visualization during Implantation

Ramovecchi¹,

Franco²,

Barbera³

2022

Journal of Current Glaucoma Practice

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A bstract The Xen Gel Stent (Allergan, Irvine, CA, USA) is a hydrophilic collagen-based gelatin tube of 6 mm in length which creates a channel of communication between the anterior chamber and the subconjunctival space allowing aqueous humor outflow. XEN is an ab interno , minimally invasive, glaucoma surgery device which has a better safety profile and offers a less invasive way of lowering intraocular pressure. Unfortunately, one of its weaknesses is that visualization of the implant during surgery is difficult, and this difficulty may be exacerbated, for instance, by a subconjunctival hemorrhage. The purpose of this paper is to describe a simple and effective technique for improving device visualization (XEN 45 μm) during the implantation. How to cite this article: Ramovecchi V, Franco F, Barbera GR. XEN Gel Staining with Trypan Blue: A Simple and Effective Technique to Improve Device Visualization during Implantation. J Curr Glaucoma Pract 2021;15(3):161–163.

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XEN Gel Stent Early Failure-dye-enhanced Ab-externo Revision

Cited by 3 publications

References 12 publications

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

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

Bleb-related Porcine Lymphatic Outflow Is Greater from Subconjunctival compared to Subtenon Blebs

XEN Gel Staining with Trypan Blue: A Simple and Effective Technique to Improve Device Visualization during Implantation

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