scholarly journals Two‐year outcomes of minimally invasive XEN Gel Stent implantation in primary open‐angle and pseudoexfoliation glaucoma

2020 ◽  
Author(s):  
Teresa Rauchegger ◽  
Reinhard Angermann ◽  
Peter Willeit ◽  
Eduard Schmid ◽  
Barbara Teuchner
Keyword(s):  
Minimally Invasive ◽  
Stent Implantation ◽  
Open Angle ◽  
Pseudoexfoliation Glaucoma ◽  
Xen Gel Stent

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.

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.

scholarly journals Serological Levels of Anti-clathrin Antibodies Are Decreased in Patients With Pseudoexfoliation Glaucoma

2021 ◽  
Vol 12 ◽  
Author(s):  
Vanessa M. Beutgen ◽  
Norbert Pfeiffer ◽  
Franz H. Grus
Keyword(s):  
Open Angle Glaucoma ◽  
Protein Microarray ◽  
Enrichment Analysis ◽  
Normal Tension Glaucoma ◽  
Control Group ◽  
Open Angle ◽  
Pseudoexfoliation Glaucoma ◽  
Serum Samples ◽  
Protein Protein Interaction ◽  
Circulating Autoantibodies

Evidence for immunologic contribution to glaucoma pathophysiology is steadily increasing in ophthalmic research. Particularly, an altered abundance of circulating autoantibodies to ocular antigens is frequently observed. Here, we report an analysis of autoantibody abundancies to selected antigens in sera of open-angle glaucoma patients, subdivided into normal-tension glaucoma (N = 31), primary open-angle glaucoma (N = 43) and pseudoexfoliation glaucoma (N = 45), vs. a non-glaucomatous control group (N = 46). Serum samples were analyzed by protein microarray, including 38 antigens. Differences in antibody levels were assessed by ANOVA. Five serological antibodies showed significantly altered levels among the four groups (P < 0.05), which can be used to cluster the subjects in groups consisting mainly of PEXG or POAG/NTG samples. Among the altered autoantibodies, anti-Clathrin antibodies were identified as most important subgroup predictors, enhancing prospective glaucoma subtype prediction. As a second aim, we wanted to gain further insights into the characteristics of previously identified glaucoma-related antigens and their role in glaucoma pathogenesis. To this end, we used the bioinformatics toolset of Metascape to construct protein-protein interaction networks and GO enrichment analysis. Glaucoma-related antigens were significantly enriched in 13 biological processes, including mRNA metabolism, protein folding, blood coagulation and apoptosis, proposing a link of glaucoma-associated pathways to changes in the autoantibody repertoire. In conclusion, our study provides new aspects of the involvement of natural autoimmunity in glaucoma pathomechanisms and promotes advanced opportunities toward new diagnostic approaches.

scholarly journals Efficacy of postoperative management with 5-fluorouracil injections after XEN Gel Stent implantation

2019 ◽  
Vol 40 (1) ◽  
pp. 235-246 ◽  
Author(s):  
Ewa Wałek ◽  
Joanna Przeździecka-Dołyk ◽  
Iwona Helemejko ◽  
Marta Misiuk-Hojło
Keyword(s):  
Stent Implantation ◽  
Primary Outcome ◽  
Open Angle Glaucoma ◽  
Postoperative Management ◽  
Age Related Macular Degeneration ◽  
Glaucoma Progression ◽  
Xen Gel Stent ◽  
Age Related ◽  
First Choice ◽  
Bleb Failure

Abstract Purpose To evaluate the efficacy of postoperative management with 5-fluorouracil injections after XEN Gel Stent implantation. Methods Prospective real-world evidence study included 39 eyes (of 36 patients) with primary open-angle glaucoma without previous glaucoma surgery and with uncontrolled intraocular pressure (IOP), glaucoma progression, or intolerance to IOP-lowering therapy. Patients underwent mitomycin C-augmented XEN implantation either as a stand-alone procedure or combined with cataract extraction. 5-Fluorouracil subconjunctival injections were a first-choice therapy for bleb failure and were administered according to predetermined criteria (analogous to pro re nata regimen in age-related macular degeneration treatment). Primary outcome was unqualified success, defined as postoperative IOP < 18 mmHg and > 20% reduction from medicated baseline without any antiglaucoma medications and no detected glaucoma progression. Results At median follow-up of 8 months (range 3–24 months), IOP decreased from a medicated baseline value of 23 mmHg (95% CI 21–24 mmHg) to 13 mmHg (95% CI 12–15 mmHg) and number of medications decreased from 3 (95% CI 2–3) to 0 (p < 0.0001 for both). Median number of 5-fluorouracil injections per eye was 3 (95% CI 2–3), and median time to first injection was 0.5 months (95% CI 0.25–3 months) after surgery. Thirteen eyes (33.3%) underwent ≥ 1 needling, and surgical revision was performed in three cases (7.7%). The primary outcome measure, which allows performing additional procedures, was achieved in 27 eyes (69%). Conclusions 5-Fluorouracil subconjunctival injections are safe and effective in postoperative management of bleb failure after XEN implantation and represent a viable alternative to other methods.

Outcomes of micropulse transscleral cyclophotocoagulation in primary open-angle glaucoma, pseudoexfoliation glaucoma, and secondary glaucoma

2020 ◽  
pp. 112067212091423 ◽  
Author(s):  
Oya Tekeli ◽  
Helin Ceren Köse
Keyword(s):  
Intraocular Pressure ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Secondary Glaucoma ◽  
Open Angle ◽  
Pseudoexfoliation Glaucoma ◽  
Transscleral Cyclophotocoagulation ◽  
The Mean ◽  
Glaucoma Group

Purpose: The aim of this study is to compare the outcomes of micropulse transscleral cyclophotocoagulation between primary open-angle glaucoma, pseudoexfoliation glaucoma, and other types of secondary glaucoma. Methods: Outcomes of 96 consecutive patients with refractory, end-stage glaucoma treated with micropulse transscleral cyclophotocoagulation were retrospectively reviewed. Follow-up examinations were performed on a regular basis until 12 months postoperatively. Surgical successes were defined as maintaining intraocular pressure ⩽18 mmHg and ⩾20% reduction in intraocular pressure (criteria A), ⩽15 mmHg intraocular pressure and ⩾25% reduction in intraocular pressure (criteria B), and ⩽12 mmHg intraocular pressure and ⩾30% reduction in intraocular pressure from baseline (criteria C). Results: Ninety-six eyes of 96 patients (50 (52%) females, 46 (48%) males) were included. Among all eyes, 32 were primary open-angle glaucoma, 30 were pseudoexfoliation glaucoma, and 34 were other types of secondary glaucoma. The mean age was 59.37 ± 11.45 (range: 20–91) years. The mean follow-up period was 14.2 ± 3.9 (range: 12–16) months. At 12 months, the success rates of primary open-angle glaucoma, pseudoexfoliation glaucoma, and secondary glaucoma group were 68.75%, 66.6%, and 64.7% (p = 0.185) for criteria A; 56.25%, 53.3%, and 50% (p = 0.153) for criteria B; and 43.75%, 43.3%, and 38.2% (p = 0.146) for criteria C. Four patients (12.5%) in primary open-angle glaucoma group, 5 patients (16.6%) in pseudoexfoliation glaucoma group, and 14 (41.2%) patients in other secondary glaucoma group required reoperation during the follow-up (p < 0.05). Conclusion: Micropulse transscleral cyclophotocoagulation is an equally effective method of lowering intraocular pressure in patients with primary open-angle glaucoma, pseudoexfoliation glaucoma, and other types of secondary glaucoma. The rate of reoperation was higher in refractory secondary glaucoma patients.

Efficacy of Needling Revision After XEN Gel Stent Implantation

2020 ◽  
Vol 29 (1) ◽  
pp. 11-14 ◽  
Author(s):  
Neha Midha ◽  
Kevin Gillmann ◽  
Ankita Chaudhary ◽  
André Mermoud ◽  
Kaweh Mansouri
Keyword(s):  
Stent Implantation ◽  
Xen Gel Stent
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