Laser Iridoplasty to Treat Iris-occluded XEN Gel Stent

To provide the first report on argon laser peripheral iridoplasty (ALPI) to restore XEN-45 Gel stent patency after iris occlusion.

Case description, laser technique, and relevant clinical imaging.

A 53-year-old African American male patient presented with progressive advanced stage primary open-angle glaucoma. Initial intraocular pressure (IOP) was 40 mm Hg, which continued to be elevated despite maximal medical therapy and selective laser trabeculoplasty. The patient underwent an uncomplicated XEN-45 Gel stent implantation and presented with an IOP of 4 mm Hg 5 days postoperatively with a functioning bleb. On postoperative day 10, the XEN lumen was found to be occluded by the iris with an IOP spike of 39 mm Hg. Anti-glaucoma treatment to induce miosis and liberate the stent was unsuccessful. ALPI was attempted to relieve the obstruction. IOP dropped to 26 mm Hg immediately post-ALPI and continued to be well-controlled 6 months later (11 mm Hg).

ALPI can effectively restore XEN Gel stent patency if occluded by the iris and should be considered before attempting more invasive surgical revisions.