Multiple XEN Gel Stents for Refractory Pediatric Glaucoma

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Minimally Invasive Glaucoma Surgery (MIGS)

Background:

• Congenital glaucoma management traditionally relies on trabeculotomy and goniotomy.
• Microinvasive glaucoma surgery (MIGS) technologies like XEN Gel Stent offer potential advantages over conventional methods, including reduced postoperative complications.
• Refractory aphakic glaucoma in a pediatric patient presented a surgical challenge after failed conventional and shunt surgeries.

Observation:

• A 10-year-old boy with aphakic glaucoma had an initial intraocular pressure (IOP) of 31 mm Hg despite maximal medical therapy.
• Previous surgical interventions, including tube shunt placement and revision, were unsuccessful in controlling IOP.
• Two treatments of micro-pulse transscleral laser therapy also failed to achieve target IOP.

Findings:

• An initial ab externo XEN Gel Stent implantation was complicated by conjunctival dehiscence and contraction within one month.
• A subsequent ab interno XEN Gel Stent implantation resulted in stable IOP (6-8 mm Hg) over a 6-month follow-up period.
• The XEN Gel Stent demonstrated efficacy in managing refractory congenital glaucoma, despite an initial complication.

Implications:

• XEN Gel Stent implantation can be an effective treatment option for complex pediatric congenital glaucoma cases unresponsive to other surgical modalities.
• Highlighting a complication underscores the importance of surgical technique and patient selection in MIGS procedures.
• Further research is necessary to compare the long-term outcomes and safety profile of XEN Gel Stent implantation against traditional glaucoma surgeries.