Abstract
The XEN Gel Stent is a surgical implant for the treatment of glaucoma unresponsive to maximum tolerated medical therapy, with higher predictability and fewer sight-threatening complications than trabeculectomy or tube shunts. While complications following XEN implantation may be less common than in other glaucoma procedures, they are not completely avoidable. This paper elaborates the most commonly reported complications following XEN implantation with an aim to mitigate their occurrence by understanding the pathophysiology behind them. In addition, the authors provide insights from the literature and their own experience and make recommendations for management when complications do occur.
Highlights
Glaucoma is the leading cause of irreversible blindness globally, and 58% of cases are believed to be primary openangle glaucoma (POAG) [1]
Trabeculectomy and tube shunt surgeries have been the most frequently performed subconjunctival outflow incisional procedures for the management of glaucoma [2], and numerous studies have evaluated the efficacy and risks associated with these procedures
In the Tube Versus Trabeculectomy Study (TVT Study) the efficacy and safety of the two procedures were evaluated in eyes with prior ocular surgery
Summary
Glaucoma is the leading cause of irreversible blindness globally, and 58% of cases are believed to be primary openangle glaucoma (POAG) [1]. Trabeculectomy and tube shunt surgeries have been the most frequently performed subconjunctival outflow incisional procedures for the management of glaucoma [2], and numerous studies have evaluated the efficacy and risks associated with these procedures. In the Tube Versus Trabeculectomy Study (TVT Study) the efficacy and safety of the two procedures were evaluated in eyes with prior ocular surgery. The study investigators found that both procedures are viable surgical options for treating medically uncontrolled glaucoma [2] and that the outcomes supported the expanding use of tube shunts beyond refractory glaucoma [3]. In the Primary Tube Versus Trabeculectomy Study (PTVT Study), investigators again found both procedures to be worthwhile for glaucoma patients, even with a cumulative probability of failure during the first year of 17.3% in the tube group and 7.9% in the trabeculectomy group [4]. The lower rate of failure in the trabeculectomy group was offset by a higher rate of complications
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