Postoperative Complications of Ab-Interno Gelatin Microstent.

PURPOSE: To report 4 previously undescribed postoperative complications in 4 cases of ab-interno XEN45 Gel Stent (XEN) implantation following uncomplicated surgeries.

PATIENTS AND METHODS: A total of 51 consecutive XEN implantations performed between July 1, 2017 and April 30, 2018 were reviewed. All cases were performed by 7 experienced glaucoma surgeons affiliated with the William Beaumont Hospital Department of Ophthalmology. Cases with postoperative complications were identified, and a literature review was performed on PubMed.gov between April 5, 2018 and June 2, 2018 to identify previously unreported XEN complications.

RESULTS: Case 1 is an 86-year-old woman who suffered a suprachoroidal hemorrhage and associated rhegmatogenous retinal detachment following XEN implantation. One month after sclerotomy drainage and pars plana vitrectomy repair, an amputated XEN was found to have eroded through the conjunctiva. Case 2 is a 68-year-old man with persistent elevated IOP due to recurrent Tenon's capsule fibrosis who developed complete XEN retraction into the subconjunctival space. Cases 3 and 4 are a 68-year-old man and a 78-year-old woman who developed occlusion of the microstent's internal ostium by a partially detached Descemet's membrane. Case 3 maintained normal IOP on timolol, whereas case 4 resulted in bleb failure, despite Nd:YAG laser lysis of the occluded XEN internal ostium.

CONCLUSIONS: While the XEN45 Gel Stent is a promising new surgical option for the management of primary open-angle glaucoma, it can present unique postoperative challenges that are still being elucidated. Timely intervention or prevention of these complications can be improved by early surgeon recognition and effective communication with co-managing ophthalmologists.