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Postoperative Complications of Ab Interno Gelatin Microstent

Rooney, David M., MD*; Shadid, Husam R., BS; Siegel, Les I., MD*,†,‡,§; Watnick, Richard L., MD*,‡,∥; Lesser, G. Robert, MD*,‡,∥; Obertynski, Thomas, MD*,‡,∥; Siegel, Marc J., MD*,†,‡,§; Citron, Matthew E., DO*,‡,§,¶; Hasbrook, Madeline, MD*; Siegel, Michael J., MD*,‡,§

doi: 10.1097/IJG.0000000000001194
Online Articles: Case Report/Small Case Series

Purpose: To report 4 previously undescribed postoperative complications in 4 cases of ab interno XEN45 Gel Stent (XEN) implantation following uncomplicated surgeries.

Patients and Methods: A total of 51 consecutive XEN implantations performed between July 1, 2017 and April 30, 2018 were reviewed. All cases were performed by 7 experienced glaucoma surgeons affiliated with the William Beaumont Hospital, Department of Ophthalmology. Cases with postoperative complications were identified, and a literature review was performed on between April 5, 2018 and June 2, 2018 to identify previously unreported XEN complications.

Results: Case 1 consisted of an 86-year-old woman who suffered a suprachoroidal hemorrhage and associated rhegmatogenous retinal detachment following XEN implantation. One month after sclerotomy drainage and pars plana vitrectomy repair, an amputated XEN was found to have eroded through the conjunctiva. Case 2 consisted of a 68-year-old man with persistent elevated intraocular pressure due to recurrent Tenon’s capsule fibrosis who developed complete XEN retraction into the subconjunctival space. Cases 3 and 4 consisted of a 68-year-old man and a 78-year-old woman who developed occlusion of the microstent’s internal ostium by a partially detached Descemet’s membrane. Case 3 maintained normal intraocular pressure on timolol, whereas case 4 resulted in bleb failure, despite Nd:YAG laser lysis of the occluded XEN internal ostium.

Conclusions: Although the XEN is a promising new surgical option for the management of primary open-angle glaucoma, it can present unique postoperative challenges that are still being elucidated. Timely intervention or prevention of these complications can be improved by early surgeon recognition and effective communication with comanaging ophthalmologists.

*Department of Ophthalmology, William Beaumont Hospital

Oakland University/William Beaumont School of Medicine

Michigan Glaucoma Specialists, Royal Oak

Michigan State University College of Human Medicine

Michigan State University College of Osteopathic Medicine, East Lansing

§Glaucoma Center of Michigan, Southfield, MI

Disclosure: The authors declare no conflict of interest.

Reprints: Michael J. Siegel, MD, Glaucoma Center of Michigan, 29201 Telegraph Rd., Suite 301 Southfield, MI 48034 (e-mail:

Received August 13, 2018

Accepted January 6, 2019

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