XEN Gel Stent
XEN Gel Stent
Author: Neervi Jain
Purpose: A minimally invasive implant used to lower intraocular pressure (IOP) in patients with moderate to severe open-angle glaucoma who have not responded to medications or laser treatments, or are not good candidates for traditional glaucoma surgery.
When it is needed:
- Moderate to severe open-angle glaucoma
- Failure of medications or laser treatment
- Need for safer, less invasive surgical option
- Desire for controlled, consistent IOP reduction with quicker recovery
Procedure:
Device: A 6 mm soft gelatin stent crosslinked with glutaraldehyde, designed to prevent hypotony using the Hagen–Poiseuille equation.
Function: Diverts fluid from the anterior chamber to the subconjunctival space to lower eye pressure.
Approaches:
- Ab interno (via inside the eye, often with conjunctival dissection)
- Ab externo (via outside the eye, through sclera, without corneal incisions)
Steps During the Procedure
Ab Interno Approach
- Anesthesia administered
- (Optional) Corneal traction suture placed
- Conjunctival peritomy and dissection performed
- Main and side port incisions made in cornea
- Anterior chamber filled with cohesive viscoelastic
- Injector inserted through main corneal incision
- Needle advanced through trabecular meshwork and sclera (2 mm behind limbus)
- Stent deployed:
- 1 mm in anterior chamber
- 3 mm in scleral wall
- 2 mm under conjunctiva
- Flow confirmed and viscoelastic removed
- Conjunctiva and Tenon’s capsule closed
Ab Externo Approach
- Anesthesia administered
- (Optional) Corneal traction suture placed
- Conjunctival peritomy and dissection performed
- Injector positioned directly into sclera, several mm from limbus
- Stent advanced into anterior chamber until visible
- Flow confirmed and stent adjusted if needed
- Conjunctiva and Tenon’s capsule sutured closed
What to Expect After Surgery
Discomfort:
Mild irritation, blurry vision, and light sensitivity (1–2 days)
Eye Protection:
Wear eye shield at night
No eye rubbing
Medications:
Use prescribed steroid and antibiotic eye drops
Restrictions (1 week):
Avoid strenuous activity, water exposure, and eye makeup
Follow-Up:
Frequent eye pressure checks
Most patients resume normal activities in 1–2 weeks
Procedure Benefits
Minimally invasive (10–30 min)
Reliable IOP reduction
Lower complication rate than traditional surgery
Faster recovery
Reduced reliance on glaucoma medications
Adjustable or revisable if needed
Procedure Risks (Rare)
Hypotony (very low eye pressure)
Stent migration, blockage, or exposure
Infection or inflammation
Macular edema
Choroidal detachment
Surgical failure
Endophthalmitis
Citations:
American Academy of Ophthalmology. XEN Gel Stent for Glaucoma. 8 May 2023.
https://www.aao.org/eye-health/treatments/xen-gel-stent-glaucoma.
Glaucoma Research Foundation. XEN Gel Stent: A Minimally Invasive Surgical Option.
https://glaucoma.org/xen-gel-stent-a-minimally-invasive-surgical-option/.
De Gregorio, A., Pedrotti, E., Stevan, G., et al. “XEN Glaucoma Treatment System in Patients With Primary Open-Angle Glaucoma: A 1-Year Multicenter Study.” European Journal of Ophthalmology, vol. 28, no. 5, 2018, pp. 498–502.
https://doi.org/10.1177/1120672118768202.
Grover, D. S., Flynn, W. J., Bashford, K. P., et al. “Performance and Safety of a New Ab Interno Gelatin Stent in Refractory Glaucoma at 12 Months.” American Journal of Ophthalmology, vol. 157, no. 6, 2014, pp. 1263–1270.e3.
https://doi.org/10.1016/j.ajo.2014.01.016.
Allergan (AbbVie). XEN® Glaucoma Treatment System: Instructions for Use. 2023.
https://www.allergan.com/products/xen-gel-stent (Official manufacturer page).
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