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Management of XEN Gel Stent Exposure with Conjunctival Erosion via Rotational Conjunctival Flap and Amniotic Membrane Transplantation—A Case Report
Background: Despite its proven effectiveness and safety profile, the XEN gel stent (Allergan Inc., CA, USA) for minimally invasive glaucoma surgery (MIGS) has a probability of postoperative complications, including postoperative hypotony, hyphema, stent migration, stent obstruction, bleb fibrosis, a...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9693404/ https://www.ncbi.nlm.nih.gov/pubmed/36363538 http://dx.doi.org/10.3390/medicina58111581 |
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author | Lee, Chang Kyu Seo, Je Hyun Lim, Su-Ho |
author_facet | Lee, Chang Kyu Seo, Je Hyun Lim, Su-Ho |
author_sort | Lee, Chang Kyu |
collection | PubMed |
description | Background: Despite its proven effectiveness and safety profile, the XEN gel stent (Allergan Inc., CA, USA) for minimally invasive glaucoma surgery (MIGS) has a probability of postoperative complications, including postoperative hypotony, hyphema, stent migration, stent obstruction, bleb fibrosis, and fibrin formation. In particular, the use of adjunctive Mitomycin-C (MMC) might be associated with bleb-related complications, including conjunctival erosion, XEN gel stent exposure, and blebitis. However, there are few studies on XEN gel stent exposure and its management. We describe a case of XEN gel stent exposure with conjunctival erosion 18 months postoperatively, which resolved effectively after combination treatment with a rotational conjunctival flap and amniotic membrane transplantation. Case presentation: A 74-year-old Korean male patient with diabetes and hypertension underwent uncomplicated ab interno XEN gel stent implantation with a subconjunctival injection of 0.1 cc of 0.02% MMC and presented with low intraocular pressure (IOP) with a well-functioning filtering bleb. Periocular pain and tearing developed 18 months after the initial operation, with mild deterioration of visual acuity to 20/100. Despite conservative medical treatment, the conjunctival erosion was not relieved. Anterior segment optical coherence tomography (AS-OCT) revealed an exposed XEN gel stent with conjunctival erosion. We performed bleb revision surgery using a rotational conjunctival flap and amniotic membrane transplantation. Slit-lamp examination and AS-OCT showed a well-formed moderate bleb without leakage, and IOP continued to be well controlled (14 mm Hg with latanoprost) until six months after bleb revision. Conclusions: This case report highlights the importance of careful examination, including slit-lamp examination, the Seidel test, and AS-OCT, to identify accurate anatomical positioning and to monitor ocular surface changes after XEN gel stent implantation with MMC or 5-FU. Combination treatment (rotational conjunctival flap and amniotic membrane transplantation) may be relatively safe for persistent XEN gel stent exposure. |
format | Online Article Text |
id | pubmed-9693404 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-96934042022-11-26 Management of XEN Gel Stent Exposure with Conjunctival Erosion via Rotational Conjunctival Flap and Amniotic Membrane Transplantation—A Case Report Lee, Chang Kyu Seo, Je Hyun Lim, Su-Ho Medicina (Kaunas) Case Report Background: Despite its proven effectiveness and safety profile, the XEN gel stent (Allergan Inc., CA, USA) for minimally invasive glaucoma surgery (MIGS) has a probability of postoperative complications, including postoperative hypotony, hyphema, stent migration, stent obstruction, bleb fibrosis, and fibrin formation. In particular, the use of adjunctive Mitomycin-C (MMC) might be associated with bleb-related complications, including conjunctival erosion, XEN gel stent exposure, and blebitis. However, there are few studies on XEN gel stent exposure and its management. We describe a case of XEN gel stent exposure with conjunctival erosion 18 months postoperatively, which resolved effectively after combination treatment with a rotational conjunctival flap and amniotic membrane transplantation. Case presentation: A 74-year-old Korean male patient with diabetes and hypertension underwent uncomplicated ab interno XEN gel stent implantation with a subconjunctival injection of 0.1 cc of 0.02% MMC and presented with low intraocular pressure (IOP) with a well-functioning filtering bleb. Periocular pain and tearing developed 18 months after the initial operation, with mild deterioration of visual acuity to 20/100. Despite conservative medical treatment, the conjunctival erosion was not relieved. Anterior segment optical coherence tomography (AS-OCT) revealed an exposed XEN gel stent with conjunctival erosion. We performed bleb revision surgery using a rotational conjunctival flap and amniotic membrane transplantation. Slit-lamp examination and AS-OCT showed a well-formed moderate bleb without leakage, and IOP continued to be well controlled (14 mm Hg with latanoprost) until six months after bleb revision. Conclusions: This case report highlights the importance of careful examination, including slit-lamp examination, the Seidel test, and AS-OCT, to identify accurate anatomical positioning and to monitor ocular surface changes after XEN gel stent implantation with MMC or 5-FU. Combination treatment (rotational conjunctival flap and amniotic membrane transplantation) may be relatively safe for persistent XEN gel stent exposure. MDPI 2022-11-02 /pmc/articles/PMC9693404/ /pubmed/36363538 http://dx.doi.org/10.3390/medicina58111581 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Case Report Lee, Chang Kyu Seo, Je Hyun Lim, Su-Ho Management of XEN Gel Stent Exposure with Conjunctival Erosion via Rotational Conjunctival Flap and Amniotic Membrane Transplantation—A Case Report |
title | Management of XEN Gel Stent Exposure with Conjunctival Erosion via Rotational Conjunctival Flap and Amniotic Membrane Transplantation—A Case Report |
title_full | Management of XEN Gel Stent Exposure with Conjunctival Erosion via Rotational Conjunctival Flap and Amniotic Membrane Transplantation—A Case Report |
title_fullStr | Management of XEN Gel Stent Exposure with Conjunctival Erosion via Rotational Conjunctival Flap and Amniotic Membrane Transplantation—A Case Report |
title_full_unstemmed | Management of XEN Gel Stent Exposure with Conjunctival Erosion via Rotational Conjunctival Flap and Amniotic Membrane Transplantation—A Case Report |
title_short | Management of XEN Gel Stent Exposure with Conjunctival Erosion via Rotational Conjunctival Flap and Amniotic Membrane Transplantation—A Case Report |
title_sort | management of xen gel stent exposure with conjunctival erosion via rotational conjunctival flap and amniotic membrane transplantation—a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9693404/ https://www.ncbi.nlm.nih.gov/pubmed/36363538 http://dx.doi.org/10.3390/medicina58111581 |
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