Outcomes of xen gel stent implantation in the inferonasal quadrant after failed trabeculectomy

Abstract

Aim and objective: To evaluate the efficacy and safety of XEN stent implantation in the inferonasal quadrant after prior failed trabeculectomy. Materials and methods: Fourteen open-angle glaucoma patients with prior failed trabeculectomy were recruited to this retrospective study. Implantation of the stent was performed as a stand-alone procedure. The mean follow-up duration was 14.2 months. Best-corrected visual acuity, intraocular pressure (IOP), number of medications, complications, and the requirement for additional procedures were among the outcome measures recorded. Results: Mean IOP reduced by 49.3% from 24.14 ± 2.74 mm Hg preoperatively to 12.23 ± 2.89 mm Hg at month 12 (p < 0.001). Medication usage reduced from 3.71 ± 0.47 medications preoperatively to 1.31 ± 1.55 at month 12 (p = 0.003). Adverse events included transient slight intracameral hemorrhage (5 eyes, 35.7%), second trabeculectomy required (2 eyes, 14.3%), and numerical hypotony (IOP <5 mm Hg, in 3 cases, 21.4%), all of which resolved spontaneously. Six eyes (42.8%) required postoperative bleb needling to further reduce IOP. There were no cases of vision loss, stent exposure, hypotony, lower eyelid malposition, bleb dysesthesia, or bleb-related infection. Conclusion: XEN gel stent implantation in the inferonasal quadrant can be considered a viable surgical option for patients with a history of previously failed trabeculectomy requiring further IOP lowering. Clinical significance: To the best of our knowledge, this is the first case series describing the outcome of inferonasal implantation of XEN gel stent following failed trabeculectomy.