Xen45 Gel Stent Combined With Healaflow Injectable Viscoelastic

To present the results of an inferonasal implantation of an ab interno Xen gel stent in a 74-year-old man suffering from uncontrolled advanced glaucoma in his left eye. For this procedure, we used Healflow as a spacer, implanting the XEN45 stent into a subconjunctival Healaflow bubble.

A 74 year old male with advanced pseudoexfoliation glaucoma and history of previous glaucoma procedures in the left eye presented to our clinic with uncontrolled IOP (28mmHg) in his left eye despite maximal tolerated medical therapy and signs of visual fields deterioration. Xen implantation for the left eye was elected. Since, the superior part the patient's conjunctiva was partially scarred, the Xen gel stent was placed inferiorly, where the conjunctiva appeared healthy and mobile.

Xen implantation was performed as a stand-alone procedure following a standardized implantation technique. At first, a volume of 0.1 ml of MMC (0.02%) was injected subconjunctivally into the nasal inferior quadrant. Subsequently, we injected 0.1 ml of Healaflow (Aptissen) subconjunctivally between the limbus and previously injected MMC. After intracameral anaesthesia the anterior chamber was filled with viscoelastic (Hanita Visco 1.8%), the Xen injector needle was inserted through a 2.4 mm corneal paracentesis incision opposite to the site of desired implantation. The needle was directed across the anterior chamber and the Xen implanted with the subconjunctival part inside the Healaflow bleb. The eye was left half filled with viscoelastic.

At postoperative day 1, the IOP decreased to 7mmHg. During the subsequent follow up, the patient developed hypothony with choroidals, that was managed conservatively with topical medications. At 6 months post operatively, the IOP was 14 mmHg with an inferior elevated bleb, complete resolution of the choroidals, and no need of topical medications.

inferior nasal implantation of the XEN 45 stent may be an option in selected cases that should be considered in patients who have undergone previous glaucoma surgeries, are at a high risk of endothelial cell loss, suffer from superior conjunctival scarring and patients that cannot undergo tube shunt procedures or CPC. An addition of subconjunctival Healaflow to the XEN implantation procedure may reduce failure rates.