Abstract：
Background: Despite its proven effectiveness and safety profile, the XEN gel stent (Allergan Inc., CA, USA) for minimally invasive glaucoma surgery (MIGS) has a probability of postoperative complications, including postoperative hypotony, hyphema, stent migration, stent obstruction, bleb fibrosis, and fibrin formation. In particular, the use of adjunctive Mitomycin-C (MMC) might be associated with bleb-related complications, including conjunctival erosion, XEN gel stent exposure, and blebitis. However, there are few studies on XEN gel stent exposure and its management. We describe a case of XEN gel stent exposure with conjunctival erosion 18 months postoperatively, which resolved effectively after combination treatment with a rotational conjunctival flap and amniotic membrane transplantation. Case presentation: A 74-year-old Korean male patient with diabetes and hypertension underwent uncomplicated ab interno XEN gel stent implantation with a subconjunctival injection of 0.1 cc of 0.02% MMC and presented with low intraocular pressure (IOP) with a well-functioning filtering bleb. Periocular pain and tearing developed 18 months after the initial operation, with mild deterioration of visual acuity to 20/100. Despite conservative medical treatment, the conjunctival erosion was not relieved. Anterior segment optical coherence tomography (AS-OCT) revealed an exposed XEN gel stent with conjunctival erosion. We performed bleb revision surgery using a rotational conjunctival flap and amniotic membrane transplantation. Slit-lamp examination and AS-OCT showed a well-formed moderate bleb without leakage, and IOP continued to be well controlled (14 mm Hg with latanoprost) until six months after bleb revision. Conclusions: This case report highlights the importance of careful examination, including slit-lamp examination, the Seidel test, and AS-OCT, to identify accurate anatomical positioning and to monitor ocular surface changes after XEN gel stent implantation with MMC or 5-FU. Combination treatment (rotational conjunctival flap and amniotic membrane transplantation) may be relatively safe for persistent XEN gel stent exposure.
摘要：
背景：尽管其经过验证的有效性和安全性，XEN凝胶支架(AllerganInc.，CA,美国）的微创青光眼手术（MIGS）具有术后并发症的概率，包括术后低张力,前房积血,支架迁移,支架阻塞,气泡纤维化，和纤维蛋白的形成。特别是,使用辅助丝裂霉素-C（MMC）可能与出血相关的并发症有关，包括结膜糜烂,XEN凝胶支架暴露，和Blebitis.然而,关于XEN凝胶支架暴露及其管理的研究很少。我们描述了一例XEN凝胶支架暴露与结膜糜烂术后18个月，旋转结膜瓣和羊膜移植联合治疗后可有效解决。病例介绍：一名74岁的韩国男性糖尿病和高血压患者接受了无并发症的abinternoXEN凝胶支架植入术，结膜下注射0.1cc0.02％MMC，并表现为低眼压（IOP）和功能良好的滤过泡。初次手术后18个月出现眼周疼痛和流泪，视力轻度下降至20/100。尽管保守治疗，结膜糜烂未缓解。前段光学相干断层扫描（AS-OCT）显示暴露的XEN凝胶支架伴结膜糜烂。我们使用旋转结膜瓣和羊膜移植进行了气泡翻修手术。裂隙灯检查和AS-OCT显示形成良好的中度气泡，无泄漏。和IOP继续得到良好控制（拉坦前列素14mmHg），直到气泡翻修后六个月。结论：本病例报告强调了仔细检查的重要性，包括裂隙灯检查，Seidel测试,和AS-OCT，用MMC或5-FU植入XEN凝胶支架后，确定准确的解剖定位并监测眼表变化。联合治疗（旋转结膜瓣和羊膜移植）对于持续的XEN凝胶支架暴露可能相对安全。
