[Open conjunctival revision after XEN45 gel stent implantation as a standardized procedure : A step by step guide. Video article]. / Offene Bindehautrevision nach XEN45-Gel-Stent-Implantation als standardisiertes Verfahren : Eine Anleitung Step by Step. Videobeitrag.

BACKGROUND: After implantation of a XEN gel stent scarring of the conjunctiva with elevation of the intraocular pressure (IOP) is a frequent occurrence. This article describes a surgical revision technique with opening of the conjunctiva and removal of scar tissue. In order to standardize the technique the surgical procedure was divided into nine steps. These steps are shown in the video and a series of images. METHODS: Surgery is divided into nine steps: 1) corneal traction suture and topical application of suprarenin, 2) opening of the conjunctiva along the limbus, 3) preparation posteriorly towards the fornix, 4) separation of the stent from the surrounding scar tissue, 5) precise preparation of the stent, 6) removal of additional scar tissue not adhering to the stent, 7) functional testing of the stent, 8) mitomycin C application, 9) closing of the conjunctiva with two corner sutures on the limbus. RESULTS: After surgery a diffuse filtering bleb is formed. In the literature increased success rates up to 90% (criterion: no further surgery necessary) after open conjunctival revision have been described. Severe side effects are not to be expected and are comparable to those of primary surgery. CONCLUSION: Open revision of the conjunctiva after XEN gel stent implantation leads to an effective and enduring lowering of IOP. Revision surgery can be carried out even after a long time period and can keep the patient free of antiglaucomatous drops. Experience in surgery of filtering blebs is advantageous when performing open revision of the conjunctiva.

Intraocular Degradation of XEN45 Gel Stent 3 Years After its Implantation.

INTRODUCTION: We report a case of XEN45 Gel Stent removal 3 years after its implantation. The stent had degraded with a closed lumen, so a new stent was implanted. CASE REPORT: A 63-year-old woman was scheduled for XEN45 Gel Stent implantation. Three years after the primary surgery and 2 years after a surgical revision, second revision surgery was required. The conjunctiva was opened, and the implanted XEN Gel Stent was stripped of the adhesive scar tissues. No aqueous humor flow was seen through the stent, and therefore, the stent was removed. The intrascleral and intracameral parts had degraded. The surface of the stent was irregular and cobbled. A part of the lumen in the middle of the stent had closed. DISCUSSION: We detected changes in the stent after its removal during the surgical revision with conjunctival opening, which is our standard approach for failed XEN Gel Stents. Most surgeons advise needling of the stent in cases of failure. However, in cases of needling, changes in the stent might not have been detected. Thus, the number of patients with similar changes as this report might be higher than the publications suggest. No unique characteristics distinguished this patient from those who had a functional XEN Gel Stent. The stent, in this case, might have been of inferior quality as an exception, or all stents might degrade over time. Therefore, gonioscopy should be performed carefully to detect any changes in the stent. In cases of suspected stent degradation, we recommend a revision surgery with conjunctival opening and removal of the stent in cases of degradation.