Premium
XEN in extreme cases
Author(s) -
Djavanmardi Shirin,
Milla Elena
Publication year - 2019
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2019.5443
Subject(s) - hyphema , quadrant (abdomen) , medicine , glaucoma , implant , intraocular pressure , ophthalmology , visual acuity , surgery
Purpose The Xen implant allows to perform a filtering procedure using a collagen tube of 6 mm in length and 45 microns of lumen usually placed in the upper nasal quadrant. Its main indication is primary open angle glaucoma, however, its versatility has allowed it to be used in other types of glaucoma cases. The aim of this communication is to present some cases in which the Xen implant has been used to treat complex situations. Methods & Results Case 1 ‐ A 31‐year‐old woman with congenital glaucoma, a history of goniotomy and a drainage device carrier of double‐plate glaucoma who presented intraocular pressure (IOP) of 17 mmHg with maximum topical and oral treatment and severe toxic ocular disease. As the upper nasal quadrant was occupied, a XEN device was implanted in the inferior nasal quadrant. During the postoperative period, displacement of the implant towards the anterior chamber was evident, but no endothelial cell loss was observed and control of the IOP was maintained at 1 year of follow‐up with a significant reduction in medication and improvement of the ocular surface. Case 2 ‐ A 34‐year‐old man presented with contusive trauma in his left eye complicated by 2‐mm hyphema and (IOP > 40 mmHg ) that could not be controlled with maximum medication. After performing a drainage of the hyphema a XEN implant was placed in the upper nasal quadrant. Since then, IOP was controlled and the visual acuity completely reestablished. Case 3 ‐ A 58‐year‐old woman with severe scleromalacia affecting all four quadrants. She had a history of trabeculectomy in the upper quadrant and a superior nasal sector of healthy conjunctiva that was normocolored and mobilizable was observed. After placing the Xen in the upper nasal sector, the patient has remained with an IOP of 16 mmHg with a beta‐blocker medication. Conclusions 1. The Xen implant can be useful in the management of glaucoma in some challenging situations. 2. The inferior nasal location of the Xen is raised exceptionally. It can make it more susceptible to displacement, although this does not necessarily affect its functioning. 3. The Xen device can be useful in acute uncontrolable ocular hypertension (ex trauma) in the context of an open angle.