Sponge-assisted intracameral length titration: a new technical modification for Ab externo XEN implantation

Accurate positioning of the XEN gel stent is critical during ab externo implantation, and fine-tuning is commonly performed with forceps, which may concentrate stress on the gelatin implant. We describe a sponge-assisted swiping maneuver using sterile ocular sponge swabs as a soft interface to achieve gradual, controlled advancement or retraction of the stent. The technique enables stepwise titration of intracameral length while reducing focal compression and the risk of device deformation during repositioning. This low-cost modification can be readily incorporated into standard ab externo XEN workflows.