Procedure could prove to be alternative to trabeculectomy.
This article was reviewed by Davinder S. Grover, MD, MPH
The subconjunctival gelatin stent (Xen45 Gel Stent, Allergan) is a valuable addition to the glaucoma specialist’s surgical armamentarium because it provides a safe, effective and predictable means of creating a new pathway for aqueous humor drainage in eyes with an atrophic collector system, Davinder S. Grover, MD, MPH, said during the 2019 American Academy of Ophthalmology annual meeting.
“Trabeculectomy is not dead, but with the availability of this minimally invasive glaucoma surgery device that creates a new outflow system, I have significantly decreased the number of cases where I need to lean on trabeculectomy and expose patients to the risks associated with a conventional filtering procedure,” said Dr. Grover, attending surgeon and clinician, Glaucoma Associates of Texas, Dallas, TX. “With proper training and postoperative care as well as scar tissue modulation, the gel stent can safely and successfully help control IOP in a large number of refractory surgical glaucoma cases.”
The stent is made of porcine gel crosslinked with glutaraldehyde. It measures 6 mm in length, has an outer diameter of 210 µm and an inner lumen diameter of 45 µm. In the United States, it is indicated for treatment of refractory open-angle glaucoma.
The stent can be used regardless of glaucoma stage, and does not have to be combined with cataract surgery.
Traditionally, the stent has been placed in an ab interno procedure with delivery through a 1.8 mm clear corneal incision, but an ab externo approach performed through the conjunctiva or a small peritomy is possible, and the technique appears to be moving in that direction, Dr. Grover said.
Presenting an intraoperative video, he provided this caution, “The surgery is not as easy as it looks, but with experience and proper training, it can be done well and provide a very safe and effective surgical treatment for glaucoma.”
“One of the greatest technical challenges is becoming familiar with the ergonomics of the slider and injector used for the procedure.”