XEN Gel Stent Open Conjunctiva Technique: A Practical Approach Paper
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PRACTICAL APPROACH
XEN Gel Stent Open Conjunctiva Technique: A Practical Approach Paper Joseph F. Panarelli . David B. Yan . Brian Francis . E. Randy Craven
Received: December 21, 2019 Ó The Author(s) 2020
ABSTRACT The Xen Gel Stent lowers intraocular pressure by shunting aqueous humor to the subconjunctival space. While published studies include both open conjunctiva and closed conjunctiva approaches, most publications feature a closed conjunctiva, ab interno approach. While this approach is widely used, other approaches may be preferred for some patients. This paper provides details on surgical steps and tips for enhancing outcomes for an open conjunctiva technique for the implantation of the Xen Gel
Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.11836185. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12325020-01278-1) contains supplementary material, which is available to authorized users. J. F. Panarelli (&) NYU Langone Health Center, New York, NY, USA e-mail: [email protected] D. B. Yan University Eye Clinic, Toronto, ON, Canada B. Francis Doheny Eye Institute, UCLA Orange County, Fountain Valley, CA, USA E. R. Craven Wilmer Eye Institute, Bethesda, MD, USA
Stent, as well as reasoning as to when this approach should be used.
Keywords: Glaucoma; Glaucoma surgery; Ophthalmology; Surgical technique; XEN Gel Stent Key Summary Points The XEN Gel Stent lowers intraocular pressure by shunting aqueous humor to the subconjunctival space. Published studies include both open conjunctiva and closed conjunctiva approaches to implantation. While the popularity of micro-invasive glaucoma surgery has favored the adaption of a closed conjunctiva approach, some surgeons have found great benefit in an open conjunctiva approach. This paper provides details on surgical steps of an open conjunctiva implantation of the gel stent and tips for enhancing outcomes.
Adv Ther
INTRODUCTION The Xen Gel Stent (Allergan) is a surgical implant designed to lower intraocular pressure (IOP) via the creation of a subconjunctival filtration pathway for aqueous humor. The device’s length (6 mm) and luminal diameter (45 lm) provide sufficient resistance to help control outflow and prevent hypotony in the early postoperative period. Multiple studies have shown that the device has an excellent safety profile and comparable efficacy to trabeculectomy and other subconjunctival drainage devices [1, 2]. Grover and colleagues reported 12-month efficacy and safety results in eyes with refractory glaucoma implanting the Xen via an ab interno approach, after opening and dissecting the conjunctiva to apply sponges soaked with mitomycin C (MMC) (0.2 mg/ml for 2 min) [1]. In contrast, the majority of published studies report a Xen implantation method without conjunctival dissection and an ab interno approach [3–5]. However, many glaucoma surgeons find that there remains a benefit to an open conjunctiva approach both for implantat
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