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Trabeculectomy Following Failed Ab Interno Gelatin Microstent

Case Series

Gizzi, Corrado*; Mohamed-Noriega, Jibran†,‡; Elkarmouty, Ahmed MBBCh, MSc, MD/PhD, FRCS(Glasg), FICO*; Scott, Andrew MD, MRCSEd, FEBO, FRCOphth, PhD*

doi: 10.1097/IJG.0000000000001000
Online Articles: Case Report/Small Case Series

Purpose: The purpose of this study is to describe the outcomes of mitomycin C (MMC)-augmented trabeculectomy performed following a failed MMC-augmented XEN-45 implantation.

Design: Retrospective case series.

Methods: All consecutive cases of MMC-augmented trabeculectomy performed after MMC-augmented XEN-45 in the Glaucoma Service at Moorfields Eye Hospital between April 2015 and June 2017 were retrospectively reviewed.

Results: We identified 8 patients who had a trabeculectomy following a failed XEN-45 implantation. The median intraocular pressure (IOP) before and after trabeculectomy was 29.0 mm Hg (12 to 45 mm Hg) and 7.5 mm Hg (2 to 12 mm Hg), respectively. At the last follow-up, 6 cases had a single-digit IOP and 2 of them developed hypotony-related complications (1 case of late choroidal detachment and 1 case of hypotony maculopathy). The median number of glaucoma drops and the median visual acuity (logMAR) before and after trabeculectomy were 2.5 (0 to 5), and 0 and 0.17 (0 to 0.3), and 0.3 (0.17 to 0.47), respectively. At the last follow-up, 3 cases showed an avascular bleb.

Conclusions: Trabeculectomy following a failed XEN-45 implantation seems technically feasible; however, higher than expected number of cases with low IOP and avascular blebs were observed. This might be related to the cumulative effect of MMC in these cases.

*Moorfields Eye Hospital, NHS Trust

NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK

Departamento de Oftalmología, Hospital Universitario, UANL, México

Disclosure: The authors declare no conflict of interest.

Reprints: Corrado Gizzi, Flat 6, 2 Ecclesbourne Road, N1 3DG London, UK (e-mail:

Received March 13, 2018

Accepted May 27, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.