|Year : 2021 | Volume
| Issue : 4 | Page : 875
XEN® gel stent obstruction by pseudoexfoliative material
Laura Diez-Alvarez, Laia Jaumandreu, Gema Rebolleda
Department of Glaucoma, Hospital Universitario Ramón y Cajal (Irycis), Madrid, Spain
|Date of Web Publication||09-Oct-2021|
Dr. Laura Diez-Alvarez
Department of Glaucoma, Hospital Universitario Ramón y Cajal (IRYCIS), Carretera de Colmenar Km 9.100, Madrid - 28034
Source of Support: None, Conflict of Interest: None
|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
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, and blood clot 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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| References|| |
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