Management of fracture and displacement of a previously successful bilateral transconjunctival ab-externo XEN gel stent: a case report.

Abstract

Background: The XEN45 Gel Stent (XGS) is an innovative, minimally invasive glaucoma surgery device, which is typically inserted via an ab-interno method, avoiding conjunctival dissection. With increasing experience, some surgeons have advocated for a transconjunctival ab-externo approach, with or without conjunctival dissection, for the delivery of XGS.

Case presentation: A 33-year-old male patient with a history of primary open-angle glaucoma diagnosed three years ago presented to the clinic with the complaint of visual field loss. This case report presents the initial implantation of XGS in both glaucoma eyes, using the transconjunctival ab-externo technique without conjunctival dissection. However, subsequent follow-up revealed that in the left eye, the XGS had been fractured as a result of external force. Meanwhile, in the right eye, the displacement of the XGS was attributed to the surgical needlework. To facilitate re-implantation, the transconjunctival ab-externo approach with conjunctival dissection was employed to enhance the securement of the XGS.

Conclusions: The case highlights that external force and needling can cause XGS fracture and displacement. To reduce this risk, employing a transconjunctival ab-externo approach with conjunctival dissection and securing the XGS with sutures was found to decrease complications, indicating a more effective surgical strategy for XGS implantation.