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OPHTHALMIC IMAGE
Year : 2021  |  Volume : 1  |  Issue : 4  |  Page : 875

XEN® gel stent obstruction by pseudoexfoliative material


Department of Glaucoma, Hospital Universitario Ramón y Cajal (Irycis), Madrid, Spain

Date of Web Publication09-Oct-2021

Correspondence Address:
Dr. Laura Diez-Alvarez
Department of Glaucoma, Hospital Universitario Ramón y Cajal (IRYCIS), Carretera de Colmenar Km 9.100, Madrid - 28034
Spain
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_363_21

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How to cite this article:
Diez-Alvarez L, Jaumandreu L, Rebolleda G. XEN® gel stent obstruction by pseudoexfoliative material. Indian J Ophthalmol Case Rep 2021;1:875

How to cite this URL:
Diez-Alvarez L, Jaumandreu L, Rebolleda G. XEN® gel stent obstruction by pseudoexfoliative material. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Oct 21];1:875. Available from: https://www.ijoreports.in/text.asp?2021/1/4/875/327738



A 74-year-old man with advanced pseudoexfoliative glaucoma (0.9 cup-to-disc ratio and − 13.97 dB visual field mean deviation) and well-controlled glaucoma following XEN45®Gel Stent implantation (a diffuse conjunctival bleb was evident and intraocular pressure [IOP] was 16 mmHg with topical brimonidine), consulted for ocular pain 1 year after surgery. The IOP was 53 mmHg due to XEN®'s internal ostial occlusion by pseudoexfoliative material [Figure 1]a. The bleb was flat, and subconjunctival mild pigmentation was also demonstrated. The IOP remained above 30 mmHg despite treatment with four topical antiglaucoma drugs and oral acetazolamide. Although XEN® obstruction by fibrin[1],[2] and blood clot[3] has been previously described, to the best of our knowledge, this is the first documented case of a XEN® occlusion by this material. The pseudoexfoliative material and the occluded intracameral portion of the implant were successfully removed by Nd: YAG (neodymium-doped yttrium aluminum garnet) laser (3 shots, 9 mJ) [Figure 1]b. The patient was treated with ketorolac 5 mg/mL three times a day for 1 week, and no inflammatory signs were observed. The IOP was 21 mmHg with the application of three hypotensive topical agents 1 week after laser. Despite the control of the acute IOP peak once the occlusion had resolved, given the severity of glaucoma, a bleb revision with fibrosis excision and subconjunctival placement of Ologen® implant was performed 3 weeks after the laser treatment. The IOP without medication was 13 mmHg 1 month after surgery.
Figure 1: (a) Pseudoexfoliative material occluding the XEN45® Gel Stent's internal ostium. (b) The implant appearance after the Nd: YAG laser excision of the occluded intracameral portion of the XEN® Gel Stent

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gillmann K, Mansouri K, Bravetti GE, Mermoud A. Chronic intraocular inflammation as a risk factor for XEN gel stent occlusion: A case of microscopic examination of a fibrin-obstructed XEN stent. J Glaucoma 2018;27:739-41.  Back to cited text no. 1
    
2.
Scantling-Birch Y, Merzougui W, Lindfield D. Early postoperative lumen blockage of ab-interno gel stent (XEN) cleared with Nd: YAG laser. Indian J Ophthalmol Case Rep2020;68:524.  Back to cited text no. 2
    
3.
Ferreira NP, Pinto LA, Marques-Neves C. XEN gel stent internal ostium occlusion: Ab-interno revision. J Glaucoma 2017;26:e150-2.  Back to cited text no. 3
    


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