Conjunctival bleb tearing by XEN gel stent after conjunctival compression sutures

2020 ◽  
pp. 112067212097086
Author(s):  
Santiago Montolío-Marzo ◽  
Aitor Lanzagorta-Aresti ◽  
Jose Vicente Piá-Ludeña ◽  
Juan María Davó-Cabrera
Keyword(s):  
Adverse Effects ◽  
Minimally Invasive ◽  
Stent Implantation ◽  
Glaucoma Surgery ◽  
Minimally Invasive Glaucoma Surgery ◽  
Xen Gel Stent ◽  
Good Outcome ◽  
Ab Interno ◽  
Conjunctival Bleb

Purpose: As minimally invasive glaucoma surgery devices emerge, newer complications are reported. XEN gel stent is safer than classic glaucoma surgery but may also lead to severe adverse effects as hypotony. Compression conjunctival sutures are a useful treatment for overfiltration hypotony after XEN gel stent implantation, but might force bleb tearing by the implant as it gets tightly close to the sutured conjunctiva. This complication has not been previously reported. Methods: We report a patient with overfiltration hypotony after XEN gel implantation. Conjunctival compression sutures and implant relocation ab interno were performed obtaining a good outcome. As conjunctiva got tightly close to the stent, the device eroded the bleb so leakage and implant extrusion were found. Results: Bleb reconstruction by conjunctival autograft was performed in order to avoid hypotony due to continuous conjunctival leakage. Conclusion: Conjunctival compression sutures may be used for overfiltration control after XEN gel implantation but we must be aware of potential conjunctival damage due to implant erosion even if it is correctly positioned. Close follow-up and early suture release may be convenient in these patients.

Canaloplasty ab interno (AbiC) – 2-Year-Results of a Novel Minimally Invasive Glaucoma Surgery (MIGS) Technique

2020 ◽  
Author(s):  
Sara Kazerounian ◽  
Michael Zimbelmann ◽  
Martin Lörtscher ◽  
Sufian Hommayda ◽  
Irene Tsirkinidou ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Eye Drops ◽  
Medication Usage ◽  
Minimally Invasive Glaucoma Surgery ◽  
The Mean ◽  
Ab Interno

Abstract Purpose The aim of this study is to evaluate the long-term efficacy of a novel minimally invasive glaucoma surgery technique (MIGS), Ab interno Canaloplasty (AbiC). Material and Methods For this retrospective cohort study, we analysed the data of 25 eyes of 23 patients with open angle glaucoma who underwent an AbiC (6 eyes) or in case of an additional cataract, a combined cataract-AbiC procedure (“phacocanaloplasty ab interno”, 19 eyes), respectively. Postoperatively, we investigated the intraocular pressure (IOP) and the number of still required IOP-lowering medication, as well as surgery-related complications. Results Overall, the mean baseline IOP of 20.24 mmHg ± 5.92 (n = 25) was reduced to 10.64 mmHg ± 2.77 (n = 25, p < 0.001), 12.55 mmHg ± 3.33 (n = 22, p < 0.001) and 13.67 mmHg ± 2.15 (n = 21, p < 0.001) at 1 day, 1 year and 2 year follow-up visit, respectively. Compared to baseline, this implies a reduction in IOP of 47.4, 37.9 and 32.5%. An average glaucoma medication usage of 1.92 ± 1.04 was registered at baseline visit and was reduced to 0,05 ± 0,23 after 2 years of follow-up. 80% of patients were off medication. In 5 eyes (20%) further antiglaucomatous eye drops or surgical treatment were administered. The only surgical complications were hyphema in 5 eyes (20%) and a localized peripheral detachment of the Descemetʼs membrane in one eye (4%) with no late sequelae. Conclusion AbiC performed independently or combined with cataract surgery seems to be a safe and effective MIGS-technique with good long-term regulation of IOP and low risk profile.

scholarly journals Iris-Occlusion of XEN Gel Stent following Ab Externo Transconjunctival Implantation Technique

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Sunil Ruparelia ◽  
Nir Shoham-Hazon
Keyword(s):  
Intraocular Pressure ◽  
Postoperative Complications ◽  
Minimally Invasive ◽  
Stent Implantation ◽  
Rare Case ◽  
Surgical Techniques ◽  
Glaucoma Surgery ◽  
Implantation Technique ◽  
Xen Gel Stent ◽  
Elevated Intraocular Pressure

The use of minimally invasive glaucoma surgery (MIGS) devices has become increasingly common for the management of elevated intraocular pressure (IOP) in the context of glaucoma. These technologies have traditionally been associated with fewer postoperative complications than conventional surgical techniques. However, we report on a rare case of transient XEN occlusion associated with pupil dilation following XEN gel stent implantation. This case highlights that in future XEN implantations, it may be preferable to position the XEN at a lesser angle to the iris to prevent such an occlusion. The use of different positionings of XEN is performed to optimize outcomes. However, it is highlighted that complications may arise in certain circumstances.

scholarly journals Development of a microstent system for minimally invasive glaucoma surgery

2017 ◽  
Vol 3 (2) ◽  
pp. 779-781
Author(s):  
Stefan Siewert ◽  
Wolfram Schmidt ◽  
Sebastian Kaule ◽  
Stefanie Kohse ◽  
Michael Stiehm ◽  
...  
Keyword(s):  
Risk Factor ◽  
Minimally Invasive ◽  
Ex Vivo ◽  
Glaucoma Surgery ◽  
Eye Model ◽  
Minimally Invasive Glaucoma Surgery ◽  
Suprachoroidal Space ◽  
Drug Eluting ◽  
Ab Interno

AbstractGlaucoma is the leading cause of irreversible blindness worldwide. An increased intraocular pressure (IOP) is known as major risk factor. Currently, drainage devices that are implanted by means of minimally invasive glaucoma surgery (MIGS) represent a promising approach for IOP low-ering. Commercially available devices for MIGS suffer from unregulated drainage involving ocular hypotony. Further-more, long term drainage capability of current devices is limited by fibrotic encapsulation processes. Therefore, our group focusses on the development of a valved drug-eluting microstent for MIGS. Within the current work, we developed two alternative injector devices for minimally invasive mi-crostent implantation. Both injector devices were based on a cannula in which the microstent is loaded and a mandrel inside the cannula. Injector device A is designed to push the microstent out of the cannula and injector device B is de-signed to withdraw the cannula above the microstent. Manu-facturing of injector devices was conducted using rapid prototyping. Simplified polymeric microstents were manu-factured from polycarbonate based silicone elastomer. Simulated use was performed in a silicone eye model. The presented injector devices were suitable for minimally in-vasive ab interno microstent implantation into suprachoroidal space. Ongoing miniaturization of the microstent system will allow the use of a 22 G cannula in future ex vivo experiments.

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