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Glaucoma is an eye condition characterized by increased intraocular pressure that damages the retina and optic nerve, leading to irreversible blindness if left untreated. The human eye has various components, including the cornea, iris, pupil, lens, and optic nerve. Aqueous humor is secreted by the epithelium of the ciliary body in the posterior chamber and flows through the trabecular meshwork and canal of Schlemm, maintaining normal intraocular pressure. The trabecular meshwork and the canal...

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Malignant glaucoma after XEN45 implant.

S Montolío Marzo¹, A Lanzagorta Aresti¹, J M Davó Cabrera¹

¹FISABIO Oftalmología Médica, Valencia, España.

Archivos De La Sociedad Espanola De Oftalmologia

|December 23, 2018

Summary

Minimally invasive glaucoma surgery, using XEN45 implants for open-angle glaucoma, can lead to severe complications like malignant glaucoma. This case highlights the need for multidisciplinary care despite the general safety of these procedures.

Keywords:

Cirugía microinvasiva de glaucoma Glaucoma maligno Implante XEN Malignant glaucoma Minimally invasive glaucoma surgery XEN implant

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Area of Science:

Ophthalmology
Surgical Innovation
Glaucoma Management

Background:

Minimally invasive glaucoma surgery (MIGS) aims to reduce medication dependence and surgical risks for chronic open-angle glaucoma.
XEN45 implants facilitate subconjunctival drainage to lower intraocular pressure.
The increasing use of MIGS is attributed to its lower complication rates compared to traditional surgeries.

Observation:

A patient underwent phacoemulsification, intraocular lens implantation, and a XEN45 implant for glaucoma.
Four days post-operatively, the patient developed acute malignant glaucoma with stage 3 athalamia.
This severe adverse event necessitated a pars plana vitrectomy and secondary Ahmed valve implantation.

Findings:

Despite the overall trend of reduced complications with MIGS, severe adverse events can still occur.
Malignant glaucoma is a rare but serious complication following glaucoma surgery.
This case underscores that MIGS are not entirely free from significant risks.

Implications:

Careful patient selection and vigilant post-operative monitoring are crucial for MIGS.
Complex cases may require a multidisciplinary approach involving various surgical specialties.
Further research into managing and preventing severe complications associated with MIGS is warranted.