Xen45 gel stent ab interno trimming for ostium occlusion: case report

Abstract Background Despite the XEN gel stent low-risk profile, various complications following the implant have been described, including internal and external occlusion, with a consequent postoperative rise in intraocular pressure (IOP). In this case report we aimed to present a XEN45 stent internal occlusion successfully treated by trimming in situ its proximal end with a 25 G vitreous scissors using a bimanual technique. Case presentation A 63-year-old male patient affected by primary open angle glaucoma (IOP = 25 mmHg) and a full thickness macular hole in his right eye, underwent ab-interno Xen gel stent implantation and, 1 month later, a 25 G vitrectomy surgery. Despite a significant IOP reduction after stent implant, 6 days after vitrectomy, IOP increased (25 mmHg) and the conjunctival bleb flattened following occlusion of stent internal ostium by a clot of presumed fibrinous material. The Nd:YAG laser failed to remove the clot, so that we decided to snip a small bit of the proximal end of the Xen tube (about 0,5 mm length) with a 25 G vitreous scissors, using a bimanual technique. In the postoperative day 1 and month 1, the IOP was 8 mmHg and 12 mmHg, respectively. The Anterior Segment OCT confirmed a functional, layered, filtering bleb, and the normal appearance and patency of the XEN proximal segment. No side effects from the intervention were observed. Conclusions Ab interno trimming with vitreous scissors of the occluded proximal end of the XEN stent may represent a safe, rapid and efficient method to restore aqueous humor subconjunctival drainage.

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Malignant Gastrointestinal Neuroectodermal Tumor in the Right Atrium: The First Case Report Presenting with an Extra-Gastrointestinal Mass

10.21203/rs.3.rs-620292/v1 ◽

2021 ◽

Author(s):

Zhiwen Li ◽

Xiaohong Pu ◽

Yao Fu ◽

Lin Li ◽

Yuemei Xu ◽

...

Keyword(s):

Case Report ◽

Right Atrium ◽

Tumor Location ◽

Neuroectodermal Tumor ◽

Case Presentation ◽

First Case ◽

Mitotic Figures ◽

The Right ◽

Whole Transcriptome

Abstract Background: Malignant gastrointestinal neuroectodermal tumor is an extremely rare soft tissue sarcoma which was firstly described in 2003 but until recently it had been designated as a definite new entity. According to the previous literatures, Malignant gastrointestinal neuroectodermal tumor was almost exclusively occurred in gastrointestinal tract.Case presentation: A 62-year-old male showed a mass in right atrium and the occupying mass was founded on the right ventricular diaphragm and involved the right atrium along the coronary sinus during the operation. Microscopically, the tumor characterized by the solid sheet and pseudopapillary focally architectures, and was composed of small to medium cells with round or oval nuclei, variable amount of eosinophilic or clear, and frequent mitotic figures. Immunohistochemically, the neoplastic cells were positive for S100 and SOX-10 but negative for HMB-45, A103 and CD99. EWSR1-AFTF1 rearrangement was detected by fluorescence in situ hybridization and further confirmed involving fusion of EWSR1 exon 8 with ATF1 exon 4 by whole transcriptome sequence analysis.Conclusions: This is the first case report of extra-gastrointestinal Malignant gastrointestinal neuroectodermal tumor that occurring in the right atrium，which remind of the new prospect of the tumor location.

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Bilateral Iris Atrophy after the Femtosecond Assisted Laser In Situ Keratomileusis Surgery

Case Reports in Ophthalmological Medicine ◽

10.1155/2015/127806 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Kenan Olcay ◽

Akin Cakir ◽

Sercan Koray Sagdic ◽

Eyup Duzgun ◽

Yildiray Yildirim

Keyword(s):

Anterior Segment ◽

Laser In Situ Keratomileusis ◽

Slit Lamp ◽

Vascular Plexus ◽

Case Presentation ◽

Slit Lamp Examination ◽

Corrected Visual Acuity ◽

Direct Light ◽

Iris Atrophy

Purpose. To report an unknown complication of laser in situ keratomileusis (LASIK) surgery.Case Presentation. A 28-year-old female presented with photophobia and glare to our eye service. She stated in her medical history that she had undergone femtosecond assisted LASIK surgery in both eyes 15 months ago and her symptoms started just after this surgery. On admission, her best-corrected visual acuity was 10/10 in both eyes. She had mydriatic pupils with no direct light reflex. Examination of the anterior segment revealed bilateral iris atrophy projecting within the LASIK ablation zone and a transillumination defect was remarkable on the slit lamp examination.Conclusion. We hypothesized that this condition may have been caused by the abnormally increased IOP that resulted in ischemia in the iris vascular plexus during the suction process of surgery.

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Ab Interno Trabeculotomy with Trabectome® for Refractory Primary Open-Angle Glaucoma: A Case Report

Journal of the Korean Ophthalmological Society ◽

10.3341/jkos.2011.52.4.502 ◽

2011 ◽

Vol 52 (4) ◽

pp. 502

Author(s):

Heeyoung Chung ◽

Jaewan Choi ◽

Jin Young Choi ◽

Yeon-Deok Kim

Keyword(s):

Case Report ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Open Angle ◽

Ab Interno

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Hemorrhagic Descemet Membrane Detachment during Ab Interno Canaloplasty

Case Reports in Ophthalmological Medicine ◽

10.1155/2019/3653954 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Juan Carlos Izquierdo Villavicencio ◽

Josefina A. Mejías Smith ◽

Laura A. Cañola Ramírez ◽

Natalia Agudelo Arbelaez ◽

Bárbara Rubio Lastra

Keyword(s):

Intraocular Pressure ◽

Medical Therapy ◽

Open Angle Glaucoma ◽

Rare Complication ◽

Anterior Segment ◽

Visual Axis ◽

Excessive Pressure ◽

Descemet Membrane ◽

Ab Interno ◽

Descemet Membrane Detachment

Purpose. To describe a Descemet membrane detachment in peripheral cornea after canaloplasty with ab interno approach in glaucoma. Case Report. A 60-year-old male with uncontrolled primary open-angle glaucoma (POAG) underwent ab interno canaloplasty in the left eye. The previous corrected visual acuity was 20/400 and intraocular pressure 26 mmHg with maximum medical therapy. There was evidence of minor intrastromal bleeding and limited Descemet membrane detachment during the introduction of intracanalicular viscoelastic. Speculate that the Descemet detachment occurred owing to the excessive pressure while injecting the viscoelastic. A conservative management was decided due to the size of the detachment outside the visual axis. On the first postsurgical day, the slit lamp biomicroscopy confirmed that the paralimbal extension of the pre-Descemet hemorrhage was 3mm and the radial extension was 2mm. Moreover the initial thickness of the pre-Descemet hemorrhage measurement with anterior segment OCT was 0.6mm. The follow-up was done weekly. At 3 months postoperatively, cornea recovered its transparency and morphology and intraocular pressure was 18mmHg with maximum medical therapy. Conclusion. Descemet membrane detachment by viscoelastic with partial intrastromal hematoma is a rare complication of the ab interno canaloplasty, which can be managed conservatively if it has not compromised the visual axis and has a limited extension.

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Case Report: Suprachoroidal Catheterization “ab-interno” for Treatment of Open Angle Glaucoma: “BABLY TECHNIQUE”

British Journal of Medicine and Medical Research ◽

10.9734/bjmmr/2015/14993 ◽

2015 ◽

Vol 6 (8) ◽

pp. 848-850

Author(s):

Ahmed Elbably

Keyword(s):

Case Report ◽

Open Angle Glaucoma ◽

Open Angle ◽

Ab Interno

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Evaluation of Bleb Morphology and Reduction in IOP and Glaucoma Medication following Implantation of a Novel Gel Stent

Journal of Ophthalmology ◽

10.1155/2017/9364910 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 17

Author(s):

Antonio Maria Fea ◽

Roberta Spinetta ◽

Paola Maria Loredana Cannizzo ◽

Giulia Consolandi ◽

Carlo Lavia ◽

...

Keyword(s):

Open Angle Glaucoma ◽

Anterior Segment ◽

Cell Loss ◽

Failure Group ◽

Safety Issues ◽

Xen Gel Stent ◽

Safety Parameters ◽

Success Group ◽

One Year

Objective. To evaluate the efficacy and safety of the Xen Gel Stent and provide a macro- and microscopic analyses of bleb morphology. Methods. A prospective 12-month study on patients with primary open-angle glaucoma. Patients underwent implantation of the XEN Gel Stent (Allergan INC, Dublin, Ireland) either alone or combined with a cataract surgery. Biomicroscopy, in vivo confocal microscopy (IVCM), and anterior segment-optical coherence tomography (AS-OCT) were used to assess bleb morphology. Safety parameters were adverse events, best corrected visual acuity, visual field, and corneal endothelial cell loss. A postoperative IOP ≤ 18 mmHg without or on medications was respectively defined as complete and qualified success while an IOP ≥ 18 mmHg was defined as failure. Results. Twelve eyes of 11 patients were evaluated. At one year, 5 out of 10 patients available achieved a complete success while five were qualified success. AS-OCT showed that bleb wall reflectivity was significantly higher in the failure group; IVCM revealed that stromal density was significantly lower in the success group. No safety issues were recorded. Conclusion. Implantation of the XEN Gel Stent appears to be a safe and effective procedure. AS-OCT and IVCM may be helpful in bleb assessment.

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A Case Report of Toxic Anterior Segment Syndrome, A Rare Complication After Laser in Situ Keratomileusis

10.21203/rs.3.rs-1016956/v1 ◽

2021 ◽

Author(s):

Aline Ali Ahmad ◽

Ali Othman Hamwi ◽

Rama Basem Hasan ◽

Sara Othman Hamwi ◽

Hussein Ali Ahmad ◽

...

Keyword(s):

Rare Complication ◽

Anterior Segment ◽

General Term ◽

Laser In Situ Keratomileusis ◽

Case Presentation ◽

Wide Range ◽

Blurry Vision ◽

Toxic Anterior Segment Syndrome ◽

Symptoms And Signs

Abstract Background: Laser in situ keratomileusis (LASIK) is increasingly used worldwide to correct a wide range of refractive errors. Toxic anterior segment syndrome (TASS), a noninfectious inflammatory disease with symptoms and signs that resemble bacterial infection, is a rare complication of LASIK. Case presentation: We report a case of TASS in a 42-year-old male patient after LASIK surgery in both eyes for hyperopia. Diagnosed clinically. Discussion and conclusion: Little information about complications after LASIK is available. TASS is a general term used to describe acute, sterile postoperative anterior segment reactions. Patients with TASS will often experience blurry vision with or without pain within 12 to 48 hours after surgery. Steroids have shown to be effective in resolving the inflammatory response, reducing the pain and recovering the vision.

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Conjunctival bleb tearing by XEN gel stent after conjunctival compression sutures

European Journal of Ophthalmology ◽

10.1177/1120672120970862 ◽

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.

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The treatment of a hypertrophic bleb after XEN gel implantation with the “Drainage Channel with sutures” method: a case report

BMC Ophthalmology ◽

10.1186/s12886-019-1249-0 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Kamil Yavuzer ◽

Ali Meşen

Keyword(s):

Glaucoma Surgery ◽

Lower Eyelid ◽

Minimal Invasive ◽

Drainage Channel ◽

Long Term Outcomes ◽

Case Presentation ◽

Xen Gel Stent ◽

Invasive Method ◽

Ab Interno

Abstract Background The placement of a XEN gel stent is an ab-interno, minimally invasive glaucoma surgery which provides a subconjunctival drainage pathway and decreases intraocular pressure (IOP). Case presentation A 75-year-old male patient who had undergone XEN45 gel implantation after phacoemulsification and intraocular lens implantation appealed to the clinic. A filtration bleb was seen that extended through the nasal 180 degrees of the eye which caused ectropion of the lower eyelid. The value of the IOP was 12 mm Hg (mmHg). By the “Drainage Channel with Sutures” method this complication was effectively treated. As with every new method, there is a lack of knowledge about long-term outcomes in terms of effectiveness, technique and complications. Conclusion The “Drainage Channel with Sutures” method has not been described in the literature yet. By this minimal invasive method, hypertrophic bleb complication of XEN gel implant has been successfully treated.

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