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    Expanding regimen with gel stent for surgical glaucoma management

    Surgeon’s brief learning period highlights ease of placing predictable, precise MIGS device



    My patients have done quite well. Most patients have a substantial decrease in IOP and glaucoma medications. In a peer-reviewed study of 65 patients, my colleagues and I saw a decrease in IOP of 20% or greater in 75.4% of patients, with a mean change of −9.1 mm Hg, while patients saw a mean decrease from 3.5 to 1.7 medications.6
    The eyes typically look amazing on the first day (from a glaucoma surgeon’s perspective!). Visual recovery is very rapid, as is the return to normal physical activity. I have to perform a needling technique in roughly one-third of patients. The needling technique is slightly different from the technique used with a trabeculectomy, however, and it can be safely and easily done at the slit lamp. I typically augment bleb needling procedures with 10 to 20 mcg of MMC.

    Very few of patients have had failures. The procedure is a true glaucoma surgery, so bleb needling, IOP spikes, erosions, hypotony, and choroidal detachments are possible. The beauty of the procedure is that these complications occur much less frequently than they do with traditional trabeculectomy and tube shunt surgeries.3-5


    Davinder S. Grover, MD, MPH

    E: [email protected]

    Dr. Grover is attending surgeon and clinician, Glaucoma Associates of Texas, Dallas. He is a speaker/consultant to Allergan and Reichert Technologies, and a consultant to New World Medical.



    1. 510(k) Summary: Allergan XEN Glaucoma Treatment System. FDA. Nov. 21, 2016. Accessed online Jan. 24, 2017. https://www.accessdata.fda.gov/cdrh_docs/pdf16/K161457.pdf
    2. Pérez-Torregrosa VT, Olate-Pérez Á, Cerdà-Ibáñez M, et al. Combined phacoemulsification and XEN45 surgery from a temporal approach and 2 incisions. Arch Soc Esp Oftalmol. 2016;91:415-21. doi: 10.1016/j.oftal.2016.02.006.
    3. Samuelson TW, Katz L, Wells J, et al. Randomized evaluation of the trabecular micro-bypass stent with phacoemulsification in patients with glaucoma and cataract. Ophthalmology. 2011;118:459-467. doi: 10.1016/j.ophtha.2010.07.007.
    4. DeBry PW, Perkins TW, Heatley G, et al. Incidence of late onset bleb-related complications following trabeculectomy with mitomycin. Arch Ophthalmol. 2002;120:297-300.
    5. Edmunds B, Thompson JR, Salmon JF, Wormald RP. The National Survey of Trabeculectomy III. Early and late complications. Eye (Lond). 2002;16:297-303.
    6. Grover DS, Flynn WJ, Bashford KP, et al. Performance and safety of a new ab interno gelatin stent in refractory glaucoma at 12 months. Am J Ophthalmol. 2017 Aug 4.

    Dr Davinder S. Grover, MPH
    Dr Davinder S. Grover, MPH, is attending surgeon and clinician, Glaucoma Associates of Texas, Dallas, Texas, USA. He may be reached by ...

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