Complications of XEN gel stent implantation for the treatment of glaucoma: a systematic review

Lu Gan; Lixiang Wang; Jun Chen; Li Tang

doi:10.3389/fmed.2024.1360051

Complications of XEN gel stent implantation for the treatment of glaucoma: a systematic review

Front Med (Lausanne). 2024 May 6:11:1360051. doi: 10.3389/fmed.2024.1360051. eCollection 2024.

Authors

Lu Gan^#^{1

2}, Lixiang Wang^#¹, Jun Chen¹, Li Tang¹

Affiliations

¹ Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.
² Department of Ophthalmology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.

^# Contributed equally.

Abstract

Aim: This study was aimed to summarize the complications and their management associated with XEN gel stent implantation.

Methods: A systematic review of literature was conducted using Medline (via PubMed), EMBASE, the Cochrane Library databases, and China National Knowledge Infrastructure, from their inception to February 1, 2024.

Results: A total of 48 studies published between 2017 and 2024 were identified and included in the systematic review, including 16 original studies (retrospective or prospective clinical studies), 28 case reports, and 4 case series, which followed patients for up to 5 years. Early postoperative complications of XEN gel stent implantation include hypotony maculopathy (1.9-4.6%), occlusion (3.9-8.8%), suprachoroidal hemorrhage (SCH), choroidal detachment (0-15%), conjunctival erosion, and exposure of the XEN gel stent (1.1-2.3%), wound and bleb leaks (2.1%) and malignant glaucoma (MG) (2.2%). Mid-postoperative complications of XEN gel stent implantation included migration of XEN (1.5%), ptosis (1.2%), endophthalmitis (0.4-3%), macular edema (1.5-4.3%), hypertrophic bleb (8.8%) and subconjunctival XEN gel stent fragmentation (reported in 2 cases). Late postoperative complications reported in cases included spontaneous dislocation and intraocular degradation.

Conclusion: XEN gel stent implantation is a minimally invasive glaucoma surgery (MIGS) procedure for glaucoma, known for its potential to minimize tissue damage and reduce surgical duration. However, it is crucial to note that despite these advantages, there remains a risk of severe complications, including endophthalmitis, SCH, and MG. Therefore, postoperative follow-up and early recognition of severe complications are essential for surgical management.

Keywords: XEN 45 gel stent; XEN gel stent; complications; glaucoma; review; surgery.

Publication types

Review

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Cadre Healthcare Research Program of Sichuan Province (Sichuan Cadre Research 2023–119), and the Science and Technology Planning Project of Sichuan Province (Key Research and Development Project) (no. 2020YFS0257).