Ab externo open conjunctiva XEN^® 63 μm: a novel surgical alternative in uveitic glaucoma-a case report

To describe the efficacy and safety of the ab externo open-conjunctiva XEN^® 63 μm gel stent in uveitic glaucoma.

A case report of a 15-year-old patient with bilateral uncontrolled uveitic glaucoma secondary to chronic anterior uveitis was presented. Several medical ophthalmological and rheumatological evaluation visits were conducted. Preoperative intraocular pressure was 28 mmHg in the right eye and 32 mmHg in the left eye. She underwent a trabeculectomy in her right eye developing hypotonic maculopathy and decompression retinopathy, requiring surgical revision. Considering the complications endured in the right eye, it was decided to perform an ab externo open-conjunctiva XEN^® 63 μm implant in her left eye with no postoperative complications. Postoperative course was uneventful with well-controlled intraocular pressure (11 mmHg) and no progression of glaucomatous damage, one year after the procedure. Anterior segment optical coherence tomography evidenced a well-functioning and non-encapsulated bleb along the follow up. Eventually, there were no postoperative uveitic episodes, with 40 mg Adalimumab as a steroid-sparing agent.

Uveitic glaucoma presents both clinical and therapeutic challenges. Traditional surgery such as trabeculectomy may entail postoperative complications such as hypotonic maculopathy and decompression retinopathy. This is the first case reporting the efficacy and safety of ab externo open-conjunctiva XEN^® 63 μm implant in uveitic glaucoma, highlighting its potential usefulness in such clinical scenarios.