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      The Use of Fixation Suture to Treat Inferonasal Hypertrophic Bleb after Xen Gel Stent Implant: A Case Report


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          We report a case of an inferonasal hypertrophic bleb complication which formed 5 months after Xen Gel Stent implantation for intraocular pressure (IOP) control in a primary open-angle glaucoma patient and its management using a fixation suture. The patient underwent an uneventful right-eye phacoemulsification and intraocular lens implantation combined with Xen Gel Stent ab interno implantation surgery. A month after the surgery, a second needling was performed due to a flat bleb and increased IOP. Post-needling slit-lamp examination showed a well-formed diffuse bleb in the superonasal quadrant. Two months after the needling, the patient presented with redness and irritation medially. Upon examination, a large inferonasal bleb was observed together with scarring of a previously formed superior bleb above the Xen Gel Stent implant. Fornix-based conjunctival incision technique was used to release the conjunctival scarring, and a fixation suture was used for the Xen implant in order to change the filtration direction. A Palmberg compression mattress suture was used to stop the inferior filtration. Despite an open conjunctiva surgical revision in the superior quadrant, no additional scaring was formed in the follow-up period of 20 months. There was good post-operative IOP control and formation of superiorly positioned bleb. To our knowledge, this is the first report to describe the use of a fixation suture for treating inferonasal hypertrophic bleb as a late complication of Xen Gel Stent implantation surgery.

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          Most cited references15

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          Efficacy, Safety, and Risk Factors for Failure of Standalone Ab Interno Gelatin Microstent Implantation versus Standalone Trabeculectomy

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            Micro-invasive glaucoma surgery (MIGS): a review of surgical procedures using stents

            Over the last decade several novel surgical treatment options and devices for glaucoma have been developed. All these developments aim to cause as little trauma as possible to the eye, to safely, effectively, and sustainably reduce intraocular pressure (IOP), to produce reproducible results, and to be easy to adopt. The term “micro-invasive glaucoma surgery (MIGS)” was used for summarizing all these procedures. Currently MIGS is gaining more and more interest and popularity. The possible reduction of the number of glaucoma medications, the ab interno approach without damaging the conjunctival tissue, and the probably safer procedures compared to incisional surgical methods may explain the increased interest in MIGS. The use of glaucoma drainage implants for lowering IOP in difficult-to-treat patients has been established for a long time, however, a variety of new glaucoma micro-stents are being manufactured by using various materials and are available to increase aqueous outflow via different pathways. This review summarizes published results of randomized clinical studies and extensive case report series on these devices, including Schlemm’s canal stents (iStent®, iStent® inject, Hydrus), suprachoroidal stents (CyPass®, iStent® Supra), and subconjunctival stents (XEN). The article summarizes the findings of published material on efficacy and safety for each of these approaches.
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              Comparison of the iCare rebound tonometer and the Goldmann applanation tonometer over a wide IOP range.

              The aim of this study was to compare the intraocular pressure (IOP) results measured by the iCare rebound tonometer with those obtained by the Goldmann applanation tonometer (GAT) over a wide range of IOP values. Furthermore, the comfort level of the iCare measurement was evaluated. The study included 75 eyes of 75 patients. The patients were divided into three groups (7-15 mmHg n = 25, 16-22 mmHg n = 25, 23-60 mmHg n = 25). The measurements were taken by two independent observers in a masked fashion. All patients were asked about discomfort during the iCare measurement. To establish the agreement between the two devices, a Bland-Altman analysis was performed. Overall, the 95% confidence interval of the differences between the two devices was -8.67 to 10.25 mmHg and in 62.7%, the iCare measurement was within +/-3 mmHg of the GAT measurements. The distribution of the differences in IOP was similar, from 7-22 mmHg. In the higher IOP range (23-60 mmHg), however, the deviation was almost twice as large. The measurement with the iCare tonometer was well tolerated; 100% of the patients denied any discomfort. The iCare tonometer is a mobile alternative to GAT in a low to moderate IOP range, but our findings show a greater deviation than previously reported. In high IOP values, measurements with the iCare tonometer do not correlate well with GAT.

                Author and article information

                Case Rep Ophthalmol
                Case Rep Ophthalmol
                Case Reports in Ophthalmology
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.com )
                Jan-Apr 2022
                4 April 2022
                4 April 2022
                : 13
                : 1
                : 253-258
                [1] aInstitute of Eye Surgery, UPMC Whitfield, Waterford, Ireland
                [2] bInstitute of Eye Surgery, UPMC Kildare, Clane, Ireland
                [3] cNutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology West Campus, Waterford, Ireland
                [4] dHospital Clinico San Carlos, Madrid, Spain
                Author notes
                *Jasna Pavičić-Astaloš, jasna@ 123456ioes.ie
                Copyright © 2022 by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial-4.0 International License (CC BY-NC) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.

                : 21 October 2021
                : 28 February 2022
                : 2022
                Page count
                Figures: 2, References: 15, Pages: 6
                Case Report

                xen gel stent,inferonasal bleb,microinvasive glaucoma surgery complications,fixation suture


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