Ab Interno Approach of Subconjunctival Filtration with Xen Gel Stent

Mini Review

Austin Ophthalmol. 2016; 1(1): 1002.

Ab Interno Approach of Subconjunctival Filtration with Xen Gel Stent

Keskin AM, Sevim DG*, Unlu M and Mirza GE

Department of Ophthalmology, Erciyes University, Turkey

*Corresponding author: Duygu Gulmez Sevim, Department of Ophthalmology, Erciyes University Faculty of Medicine, Yeni Mah, Talas Bulvari, 38039, Melikgazi, Kayseri, Turkey

Received: August 02, 2016; Accepted: August 25, 2016; Published: August 26, 2016

Abstract

The XEN implantation is an ab interno technique of minimally invasive (or microincisional) glaucoma surgery (MIGS). It is a gelatin stent under investigation that would be implanted via a clear corneal incision without conjunctival dissection. Three 6.0mm long implants, each with an internal diameter for varying levels of Intraocular Pressure (IOP) control, were designed. It is injected through a small corneal incision using a simple, preloaded IOLlike injector. There are few articles about XEN gel stent and in these studies successful results have been achieved as a result of less traumatic surgical procedures than traditional glaucoma surgeries. In all cases, subconjunctival MMC injection was applied before the surgery. Also, most of the surgeries were combined with phacoemulsification and this should be taken into account while considering IOP reduction. In conclusion, more studies with higher numbers of patients and with more follow up are necessary.

Keywords: Glaucoma; Microincisional glaucoma surgery; Minimally invasive glaucoma surgery; Xen gel stent; Xen implantation

Abbreviations

SLT: Selective Laser Trabeculectomy; MIGS: Minimally Invasive (Or Microincisional) Glaucoma Surgery; IOP: Intraocular Pressure; POAG: Primer Open Angle Glaucoma; MMC: Mitomycin C

Introduction

Since glaucoma is one of the most important causes of irreversible blindness worldwide, new medical and surgical treatment options are needed to investigate. While many patients can be controlled with medications, patient adherence and ocular toxicity are major issues in the developed world, and lifetime costs and accessibility to medications are issues in developing regions [1]. Laser treatment options, especially Selective Laser Trabeculectomy (SLT), are noninvasive, non-medication treatment approaches, but its efficiency commonly decreases over time [2]. Therefore, surgery becomes significant for the long-term treatment. Although effectiveness of trabeculectomy and tube is evidently proved, short or long-term complications prompt the new investigations. Tube and trabeculectomy patients have similar rates of vision-threatening complications such as blebitis, endophthalmitis, or choroidal haemorrhage [3].

In order to decrease the rate of complications, different MIGS techniques have been developed. Those aim to provide a safer, less invasive means of reducing IOP than traditional surgery, with the goal of reducing dependency on topical medications.

Xen Gel Stent

The XEN implantation is an ab interno technique of MIGS. The XEN gel stent (Aquesys, Inc., Aliso Viejo, CA, USA) is a gelatin stent under investigation that would be implanted via a clear corneal incision without conjunctival dissection (Figure 1) [4,5].

Citation:Keskin AM, Sevim DG, Unlu M and Mirza GE. Ab Interno Approach of Subconjunctival Filtration with Xen Gel Stent. Austin Ophthalmol. 2016; 1(1): 1002.