XEN Gel Stent
XEN Gel Stent Surgery in Texas
Author: Neervi Jain
It is a minimally invasive glaucoma procedure meant to lower intraocular pressure (IOP) in certain open-angle glaucoma patients. By adding a small gelatin-based implant, the aqueous humor has another way to get from the anterior chamber to the subconjunctival space, where it can be taken. Doing this can help lower eye pressure and keep the optic nerve from getting worse from glaucoma.
Patients considering XEN Gel Stent Surgery in Texas can receive a comprehensive glaucoma evaluation to determine whether this procedure is appropriate. XEN Gel Stent Surgery in North Texas may be considered when medications or laser treatment have not provided sufficient pressure control.
What Is the XEN Gel Stent?
The XEN Gel Stent is a small, bendable device that is meant to allow controlled drainage of aqueous humor. A minimally invasive surgery is used to put it in place, and it gives fluid another way to leave the eye.
As a type of minimally invasive glaucoma surgery, XEN may lower pressure while needing less work on the tissue than regular filtering surgery. Patients looking for XEN glaucoma surgery near Durant OK, might benefit from an exam at a nearby Texoma retina, a glaucoma center in North Texas.
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 a 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)
How Does XEN Gel Stent Surgery Work?
In glaucoma, problems draining fluid can lead to high IOP and damage to the visual nerve that gets worse over time. The XEN implant creates a path from the anterior chamber to the subconjunctival space. The fluid then gathers under the eye and is taken up by the tissues around it.
Open-angle glaucoma surgery with an XEN gel stent may help some patients get the pressure relief they need and may also make them less dependent on their glaucoma medications. Eye pressure reduction surgery should always The choice of treatment will depend on the type of glaucoma, its severity, the target IOP, previous treatments, and the structure of the patient’s eye.
Who May Be a Candidate?
XEN Gel Stent treatment may be an option for some people who have:
- Primary open-angle glaucoma
- Pseudoexfoliative or pigmentary glaucoma
- Inadequately controlled IOP despite medications
- Previous laser treatment with insufficient pressure control
- A need for additional pressure reduction
Individuals seeking glaucoma treatment in Sherman TX can undergo diagnostic tests and a personalized surgical assessment. Occasionally, a minimally invasive filtering method is better than XEN Gel Stent Surgery for Glaucoma in Sherman, TX.
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 the 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 an eyeshield 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).
Frequently Asked Questions
It makes an extra way for aqueous humor to drain into the space under the conjunctiva, which lowers IOP.
It might be an option for some people with open-angle glaucoma whose IOP isn't well managed with medications or other treatments.
Yes, XEN is usually thought of as a minimally invasive glaucoma procedure, even though it filters the fluid under the cornea.
Some people with glaucoma may need fewer medications, but the effects are different for each person.
The procedure is usually done as a fairly short outpatient glaucoma surgery. The exact length of time depends on how the surgery is done and the patient's health.
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