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OPHTHALMIC IMAGE
Year : 2020  |  Volume : 68  |  Issue : 3  |  Page : 524

Early postoperative lumen blockage of ab-interno gel stent (XEN) cleared with Nd:YAG laser


1 Department of Medicine, University of Southampton, Southampton, UK
2 Department of Ophthalmology, Royal Surrey County Hospital, Guildford, UK

Date of Web Publication14-Feb-2020

Correspondence Address:
Dr. Yarrow Scantling-Birch
Department of Ophthalmology, Royal Surrey County Hospital, Egerton Road, Guildford - GU2 7XX, Surrey
UK
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1051_19

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How to cite this article:
Scantling-Birch Y, Merzougui W, Lindfield D. Early postoperative lumen blockage of ab-interno gel stent (XEN) cleared with Nd:YAG laser. Indian J Ophthalmol 2020;68:524

How to cite this URL:
Scantling-Birch Y, Merzougui W, Lindfield D. Early postoperative lumen blockage of ab-interno gel stent (XEN) cleared with Nd:YAG laser. Indian J Ophthalmol [serial online] 2020 [cited 2020 May 27];68:524. Available from: http://www.ijo.in/text.asp?2020/68/3/524/278339



A 72-year-old lady underwent combined phacoemulsification, goniosynechiolysis, and ab-interno gel stent implantation (XEN, Allergan) for primary angle closure glaucoma (PACG). The surgery was uneventful with intracameral and subconjunctival dexamethasone used to minimize inflammation. The intraocular pressure (IOP) on Day 1 was 16 mmHg, but the proximal segment was obstructed by fibrin [Figure 1]a, secondary to iris manipulation during goniosynechiolysis. Four shots (1.5 mJ) of Nd:YAG laser (Magna View Gonio lens, Ocular Instruments®) successfully cleared the stent lumen [Figure 1]b and IOP reduced to 12 mmHg. There were no ill effects to the stent lumen or external appearance and no other side effects from the intervention were observed. The post laser IOP remained stable at 15 mmHg (1 month) and 20 mmHg (2 months). Early lumen blockage can occur in 4% of gel stent procedures (blood, fibrin, or iris),[1] or later due to continued inflammation[2] in a primary open-angle glaucoma cohort. The Nd:YAG laser should be considered in treating stent lumen obstruction.
Figure 1: (a). Slit lamp examination of left eye showing fibrin plug in proximal segment of XEN stent. (b). Post YAG laser lumen clearance 30 min after treatment

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Acknowledgements

The authors would like to thank the hospital colleagues that continue to support the eye unit at the Royal Surrey County Hospital.

Declaration of patient consent

The authors certify that they have obtained all the appropriate consent. The patient has given her verbal consent for her images and clinical information to be reported in the journal. The patient understands that her name and initials will not be published, and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

Yarrow Scantling-Birch and Wassim Merzougui declare no conflicts of interest. Dan Lindfield has previously received honoraria from Allergan.



 
  References Top

1.
Karimi A, Lindfield D, Turnbull A, Dimitriou C, Bhatia B, Radwan M, et al. A multi-centre interventional case series of 259 ab-interno Xen gel implants for glaucoma, with and without combined cataract surgery. Eye (Lond) 2019;33:469-77.  Back to cited text no. 1
    
2.
Gillmann K, Mansouri K, Bravetti GE, Mermoud A. Chronic intraocular inflammation as a risk factor for XEN gel stent occlusion: A case of microscopic examination of a fibrin-obstructed XEN stent. J Glaucoma 2018;27:739-41.  Back to cited text no. 2
    


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