What is XEN Gel Stent?
The XEN Gel Stent is a tiny, soft, flexible subconjunctival implant measuring about 6-mm in length and the width of a human hair that is inserted into the eye using an injector system during a minimally invasive glaucoma surgery to treat open-angle glaucoma.
Glaucoma is an eye condition characterized by damage of the optic nerve due to increased intraocular pressure (IOP) or internal eye pressure. The increase in eye pressure is a result of accumulation of eye fluid (aqueous humour). This may be due to the production of too much fluid in the eye or the inability of fluid to drain out properly from the eye. If left untreated, glaucoma can lead to progressive vision loss and ultimately blindness.
The implant is placed just below the conjunctiva, a clear membrane that covers the sclera (white of your eye), through a small, self-sealing corneal incision to provide an outflow path for the accumulated aqueous humour from the anterior chamber to the subconjunctival space in order to lower intraocular pressure. The stent is designed to stay permanently in the eye and is made up of a collagen-derived non-inflammatory gelatine material that allows it to attach to the ocular tissue naturally, potentially minimising several issues seen with stents made of synthetic materials, such as erosion, migration, and corneal damage.
Indications for XEN Gel Stent
The XEN Gel Stent is indicated for use in patients with:
- Primary open angle glaucoma
- Refractory glaucoma with failed surgical treatment
- Pigmentary or pseudoexfoliation glaucoma with open angles that have failed medical therapy
Preparation for XEN Gel Stent Procedure
Preoperative preparation for XEN Gel Stent procedure will involve the following steps:
- A thorough eye examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
- You should refrain from using makeup or lotion around the eyes a few days prior to the surgery.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
- Refrain from smoking pre- and post-procedure for a specific period of time, as this may hamper proper healing.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- Arrange for someone to drive you home as you will not be able to drive yourself after surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for XEN Gel Stent Implantation
The XEN Gel Stent implantation is mostly performed under local anaesthesia, where your doctor inserts the stent device into the eye through a minimally invasive surgical procedure. The surgery involves the following steps:
- Your surgeon will first numb your eye with anesthetic eye drops.
- An eyelid holder will be placed on your eye to prevent the eye from blinking.
- A small, self-sealing incision is made into the cornea to properly place the device.
- An injector system is used to position the implant carefully in the subconjunctival space.
- Subconjunctival and XEN Gel Stent placement is confirmed by your doctor, and the injector is then withdrawn.
- Once the stent is in place, it acts as a small channel in the eye to drain the accumulated eye fluid and help lower intraocular pressure.
- The incision is then closed, and a protective shield is placed over the eye to complete the operation.
Postoperative Care and Recovery
In general, postoperative care and recovery after XEN Gel Stent implantation involves the following:
- Arrange for someone to drive you home.
- You should wear a protective eye shield for at least a week at night or while napping to protect the eye from rubbing in your sleep.
- You may experience sensitivity to light, blurred vision, or tearing.
- Keep both eyes closed and rest as much as possible during recovery.
- Limit reading and watching TV for the first few days.
- Do not swim or use a hot tub, spa, or whirlpool for at least 2 weeks to reduce the risk of eye irritation and infection.
- Do not apply eye makeup, cologne, lotions, or aftershave for one week.
- Avoid strenuous activities and heavy lifting for a week so that there is no stress on the eye as it heals.
- You may notice some eye pain or discomfort for the first few days for which your doctor will prescribe medications as needed.
- Steroid and antibiotic drops as well as artificial tears are prescribed to minimize the risk of infection, dry eye, and inflammation.
- Wear sunglasses while outdoors to prevent discomfort from sun exposure and dust in the air.
- You may need to take off work for at least a week or two to facilitate recovery.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Advantages of XEN Gel Stent
Some of the advantages of XEN Gel Stent procedure over other traditional glaucoma surgeries include:
- Shorter surgery time
- Faster recovery
- High safety profile
- Minimally invasive
- Minimal damage to eye tissue
- Minimal side effects
- Reduces or eliminates the need of glaucoma eye drops
Risks and Complications of XEN Gel Stent Procedure
The XEN Gel Stent implantation is a relatively safe procedure; however, as with any eye surgery, there are potential risks and complications that may occur, such as:
- Eye pain or redness
- Wound leak
- Transient hypotony (abnormally low intraocular pressure)
- Implant migration or dislocation
- Failure to improve eye pressure