Delayed-onset Endophthalmitis Following Implantation of a XEN45 Glaucoma Device: A Case Report

The aim of this study was to present a case of delayed-onset endophthalmitis occurring after the implantation of a XEN45 device.

The patient was a 54-year-old man with bilateral elevated intraocular pressure. The patient underwent placement of a XEN45 implant in his left eye. One month postoperatively the patient required needling with adjuvant mitomycin C. Six months later, the intraocular pressure was well controlled with treatment.

Eight months after surgery, the patient presented to the emergency room and was diagnosed with left eye endophthalmitis. There was no history of trauma. The presence of erosions could not be thoroughly assessed due to significant conjunctival inflammation and friability, but a scleral necrosis patch was observed around the stent's subconjunctival pathway. The vitreous culture was positive for Streptococcus oralis. The blood culture was negative, and physical examination excluded any other endogenous cause. Given the poor clinical progression, persistent site of infection, and no visual prognosis, an enucleation was performed.

In the case presented, we hypothesize a perforation of the conjunctiva as the most probable cause of the patient's endophthalmitis. This case, together with previous case reports, highlights the importance of periodic patient follow-up after the procedure. However, less invasive and seemingly safer new generation implants for glaucoma surgery are not fully devoid of complications.