The Use of Fixation Suture to Treat Inferonasal Hypertrophic Bleb after Xen Gel Stent Implant: A Case Report

The Use of Fixation Suture to Treat Inferonasal Hypertrophic Bleb after Xen Gel Stent Implant: A Case Report

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We report a case of an inferonasal hypertrophic bleb complication which formed 5 months after Xen Gel Stent implantation for intraocular pressure (IOP) control Exhaust Systems in a primary open-angle glaucoma patient and its management using a fixation suture.The patient underwent an uneventful right-eye phacoemulsification and intraocular lens implantation combined with Xen Gel Stent ab interno implantation surgery.A month after the surgery, a second needling was performed due to a flat bleb and increased IOP.Post-needling slit-lamp examination showed a well-formed diffuse bleb in the superonasal quadrant.Two months after the needling, the patient presented with redness and irritation medially.

Upon examination, a large inferonasal bleb was observed together with scarring of a previously formed superior bleb above the Xen Gel Stent implant.Fornix-based conjunctival incision technique was used to release the conjunctival scarring, and a fixation suture was used for the Xen implant in order to change the filtration direction.A Palmberg compression mattress suture was used to stop the inferior filtration.Despite an open conjunctiva surgical revision in the superior quadrant, no additional scaring was formed in the follow-up period of 20 months.There was good post-operative IOP control and formation of superiorly positioned bleb.

To our knowledge, this is the first report to describe the use of a fixation suture for treating inferonasal hypertrophic bleb as a late complication ULTIMATE 3-6-9 1200MG of Xen Gel Stent implantation surgery.