Recommendations for the management of elevated intraocular pressure due to bleb fibrosis after XEN gel stent implantation

Abstract

Vanessa Vera,1 Arsham Sheybani,2 Dan Lindfield,3 Ingeborg Stalmans,4 Iqbal Ike K Ahmed5 1Department of Glaucoma, Unidad Oftalmologica de Caracas, Caracas, Venezuela; 2Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, MO, USA; 3Department of Ophthalmology, Royal Surrey County Hospital, Guildford, Surrey, UK; 4Glaucoma Unit, University Hospitals UZ Leuven, Leuven, Belgium; 5Glaucoma and Advanced Anterior Segment Surgery, University of Toronto, Toronto, ON, Canada Abstract: Surgical management of glaucoma offers a means of effective disease control. A gel stent that facilitates drainage to the subconjunctival space offers intraocular pressure (IOP) reduction similar to traditional glaucoma filtering surgeries in a less invasive manner. However, like all subconjunctival filtering procedures that result in a bleb, fibrosis can present as a cause of elevated IOP. The following proposed techniques and recommendations for managing elevated IOP due to bleb fibrosis after gel stent implantation are based on the clinical experience of the authors. The goal of this paper is to improve outcomes following gel stent surgery by providing guidance on assessment of bleb function and strategies for bleb enhancement. Keywords: glaucoma gel stent, bleb management, bleb fibrosis, glaucoma surgery, glaucoma filtering surgery, bleb needling

Keywords

• XEN Gel Stent
• bleb management
• bleb fibrosis
• bleb needling
• gel stent surgery