Short communication
Usefulness of the amniotic membrane graft in the management of xen® implant exposure
Utilidad del injerto de membrana amniótica en el manejo de la exposición del implante XEN®
I. Bugallo González
, D. Álvarez Fernández, C. Rodríguez Balsera, L. Fernández Díaz, M.J. Viescas Fernández, M.L. Álvarez Suárez
Corresponding author
Servicio de Oftalmología, Hospital Vital Álvarez-Buylla, Mieres, Asturias, Spain
Read
Not available
Timeswas read the article
Total PDF
Total HTML
Share statistics
array:24 [ "pii" => "S2173579423000683" "issn" => "21735794" "doi" => "10.1016/j.oftale.2023.04.012" "estado" => "S300" "fechaPublicacion" => "2023-06-01" "aid" => "2097" "copyright" => "Sociedad Española de Oftalmología" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2023;98:351-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0365669123000680" "issn" => "03656691" "doi" => "10.1016/j.oftal.2023.03.004" "estado" => "S300" "fechaPublicacion" => "2023-06-01" "aid" => "2097" "copyright" => "Sociedad Española de Oftalmología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2023;98:351-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Comunicación corta</span>" "titulo" => "Utilidad del injerto de membrana amniótica en el manejo de la exposición del implante XEN®" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "351" "paginaFinal" => "354" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Usefulness of the amniotic membrane graft in the management of the exposure of the XEN® implant" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1551 "Ancho" => 1674 "Tamanyo" => 359306 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A) Tomografía de coherencia óptica e imagen de segmento anterior: extremo distal del XEN® protruyendo la conjuntiva. B) Tomografía de coherencia óptica e imagen de segmento anterior: exposición extremo distal del XEN® a través de la conjuntiva.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Bugallo González, D. Álvarez Fernández, C. Rodríguez Balsera, L. Fernández Díaz, M.J. Viescas Fernández, M.L. Álvarez Suárez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Bugallo González" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Álvarez Fernández" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Rodríguez Balsera" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Fernández Díaz" ] 4 => array:2 [ "nombre" => "M.J." "apellidos" => "Viescas Fernández" ] 5 => array:2 [ "nombre" => "M.L." "apellidos" => "Álvarez Suárez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579423000683" "doi" => "10.1016/j.oftale.2023.04.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579423000683?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669123000680?idApp=UINPBA00004N" "url" => "/03656691/0000009800000006/v1_202305311245/S0365669123000680/v1_202305311245/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173579423000440" "issn" => "21735794" "doi" => "10.1016/j.oftale.2023.04.001" "estado" => "S300" "fechaPublicacion" => "2023-06-01" "aid" => "2098" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2023;98:355-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Delayed suprachoroidal hemorrhage after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK)" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "355" "paginaFinal" => "359" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hemorragia supracoroidea diferida después de queratoplastia endotelial automatizada con pelado de la membrana de Descemet (DSAEK)" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 657 "Ancho" => 987 "Tamanyo" => 72104 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Case 1, 24<span class="elsevierStyleHsp" style=""></span>h after DSAEK. Shallow anterior chamber with 1<span class="elsevierStyleHsp" style=""></span>mm hyphema and iris contacting the endothelium. Lenticule is well positioned.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Oliver-Gutierrez, S. Martin Nalda, G. Segura-Duch, P. Buck, E. Ros-Sanchez, L. Bisbe" "autores" => array:6 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Oliver-Gutierrez" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Martin Nalda" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Segura-Duch" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Buck" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Ros-Sanchez" ] 5 => array:2 [ "nombre" => "L." "apellidos" => "Bisbe" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669123000692" "doi" => "10.1016/j.oftal.2023.03.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669123000692?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579423000440?idApp=UINPBA00004N" "url" => "/21735794/0000009800000006/v1_202306011103/S2173579423000440/v1_202306011103/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173579423000786" "issn" => "21735794" "doi" => "10.1016/j.oftale.2023.05.004" "estado" => "S300" "fechaPublicacion" => "2023-06-01" "aid" => "2110" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Arch Soc Esp Oftalmol. 2023;98:344-50" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Update on the diagnosis and treatment of normotensive glaucoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "344" "paginaFinal" => "350" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Actualización en el diagnóstico y tratamiento del glaucoma normotensivo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L.C. Gutiérrez Martín" "autores" => array:1 [ 0 => array:2 [ "nombre" => "L.C." "apellidos" => "Gutiérrez Martín" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669123000874" "doi" => "10.1016/j.oftal.2023.04.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669123000874?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579423000786?idApp=UINPBA00004N" "url" => "/21735794/0000009800000006/v1_202306011103/S2173579423000786/v1_202306011103/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Usefulness of the amniotic membrane graft in the management of xen® implant exposure" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "351" "paginaFinal" => "354" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "I. Bugallo González, D. Álvarez Fernández, C. Rodríguez Balsera, L. Fernández Díaz, M.J. Viescas Fernández, M.L. Álvarez Suárez" "autores" => array:6 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Bugallo González" "email" => array:1 [ 0 => "inbugallo@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Álvarez Fernández" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Rodríguez Balsera" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Fernández Díaz" ] 4 => array:2 [ "nombre" => "M.J." "apellidos" => "Viescas Fernández" ] 5 => array:2 [ "nombre" => "M.L." "apellidos" => "Álvarez Suárez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Hospital Vital Álvarez-Buylla, Mieres, Asturias, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad del injerto de membrana amniótica en el manejo de la exposición del implante XEN®" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1551 "Ancho" => 1674 "Tamanyo" => 360334 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Optical coherence tomography and anterior segment imaging: distal end of XEN® protruding the conjunctiva. (B) Optical coherence tomography and anterior segment imaging: XEN® distal end exposure through conjunctiva</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In recent years, the development of minimally invasive glaucoma surgery techniques (MIGs) has given rise to important changes in the classic treatment schemes for this disease. The XEN® 45 implant (Allergan, Dublin, Ireland) is one of the most widely used within these techniques. It is a non-valved collagen tube that allows drainage of the aqueous humour via the subconjunctival route. The main advantage of these devices over conventional surgeries such as trabeculectomy is their high safety profile.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Given the low frequency of complications associated with the XEN® and its relatively recent commercialisation (November 2016), data on the management of these complications are scarce, so the presentation of our case and the surgical technique performed is of particular interest.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical case</span><p id="par0010" class="elsevierStylePara elsevierViewall">The case of a 79-year-old female is presented, exhibiting mild cognitive impairment, with a history of chronic advanced open-angle glaucoma (mean defect −20.5 decibels) in treatment with 2 active ingredients (bimatoprost and timolol), without progression, but with significant periorbitopathy and conjunctival hyperemia producing suboptimal adherence. She reported blurred vision and a foreign body sensation in the left eye, which did not improve with artificial tears or corticosteroids. Examination revealed a best corrected visual acuity (BCVA) of 0.3 and an intraocular pressure (IOP) of 18 mm of mercury (mm Hg). A diagnosis of cataract was made and combined surgery with XEN® implantation was considered, given the aforementioned circumstances. Conventional cataract surgery was performed, followed by XEN® implantation with subconjunctival injection of 0.1 mL of 0.02% mitomycin C (MMC), without incident. The immediate postoperative course was favourable. However, after 2 weeks, a superficial location of the distal end of the tube began to be observed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), and finally, one month after the operation, it was found to be exposed through the overlying conjunctiva (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B) with an IOP of 5 mmHg. In view of the hypotony and the risk of infection, a new operation was decided. During surgery, the conjunctiva was opened from 9 to 11 h, the distal end of the XEN® was fixed to the sclera with a 10−0 nylon stitch (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), to adapt the subconjunctival trajectory of the tube to the curvature of the globe and thus move the end away from the conjunctiva, covering with a double layer of amniotic membrane with the epithelial side facing upwards sutured to the sclera adjacent to the sclerocorenal limbus with 2 stitches of 10−0 nylon and closure by advancement of the conjunctiva with a loose stitch of 9−0 nylon. On the first postoperative day, the implant remained well positioned and completely covered, with an IOP of 10 mmHg, with good evolution in subsequent checkups (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Six months after the second operation, the BCVA was 0.8, the XEN® was normally positioned and IOP was 13 mmHg, without topical treatment and with no progression of the disease.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">XEN® is a device with widely proven efficacy and safety but not free of complications, one of which is conjunctival erosion, with consequent exposure of the implant and the associated risk of hypotension and infection.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–5</span></a> Several risk factors for XEN® exposure have been described: use of antimetabolites such as MMC, conjunctival tissue degeneration in the elderly population, nasal location of the implant and a short subconjunctival tract <1.5 mm.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a> In our patient, all the above associated risk factors were present, except the last one, although the subconjunctival trajectory of the implant was 2 mm, 1 mm shorter than recommended by the manufacturer. In addition, we believe that frequent eye rubbing as reported by the patient, and the altered surface due to chronic medication use, contributed to the conjunctival erosion.</p><p id="par0020" class="elsevierStylePara elsevierViewall">On the one hand, this case is presented due to the off-label indication of XEN®, because it is an advanced glaucoma and, most of the time, it is indicated for mild-moderate glaucoma. In our case, it was decided to perform combined surgery in an attempt to avoid the use of topical medication, taking into account the clinical characteristics of the patient: a person with cognitive impairment, poor tolerance to topical treatment and poor compliance with treatment. On the other hand, the surgical technique used to resolve the subsequent complication of conjunctival erosion and extrusion of the XEN® combines the use of amniotic membrane and appositional suture, which allows adaptation of the route of the tube under the conjunctiva. In the literature we found two cases of the use of amniotic membrane, which has anti-inflammatory properties and growth factors, described by Fea et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and Arnould et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> but both involve conjunctival autografting, which was not performed in our intervention due to conjunctival fragility caused by chronic medication. Other techniques used for the resolution of XEN® exposure have been the repositioning of the implant through an anterior chamber<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and section of the implant via external ab.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> However, the combination of amniotic membrane grafting with appositional suturing has only been described by Ahmed in a surgical video, with no further data in the literature. Therefore, this relatively simple technique has demonstrated a good functional outcome in the short term without requiring additional topical medication, which constitutes an alternative to consider for the management of this rare complication, but with significant associated risks.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflict of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">No conflicts of interest were declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1906889" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1647330" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1906890" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1647329" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-01-10" "fechaAceptado" => "2023-03-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1647330" "palabras" => array:4 [ 0 => "Glaucoma" 1 => "Microsurgery" 2 => "XEN® gel stent" 3 => "Amniotic membrane" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1647329" "palabras" => array:4 [ 0 => "Glaucoma" 1 => "Microcirugía" 2 => "XEN® gel stent" 3 => "Membrana amniótica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We report a case of a 79-year-old woman with severe glaucoma and absence of therapeutic adherence, who undergone cataract surgery and XEN® implant in her left eye. Two weeks after the intervention, conjunctival erosion was observed with exposure of the distal end of the implant, so a surgical repair was performed by combining an appositional suture of the tube, adapting its trajectory to the scleral curvature, and an amniotic membrane graft. After 6 months of follow-up, the intraocular pressure is controlled, without additional treatment needed, and no disease progression.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Se presenta el caso de mujer de 79 años con glaucoma severo y falta de adherencia al tratamiento que es sometida a cirugía de catarata e implante XEN® en su ojo izquierdo. Dos semanas después de la intervención se objetiva una erosión conjuntival con exposición del extremo distal del implante, por lo que se realiza una reparación quirúrgica mediante la combinación de una sutura aposicional del tubo, adaptando su trayectoria a la curvatura escleral, y el recubrimiento con injerto de membrana amniótica. Tras 6 meses de seguimiento, presenta una presión intraocular controlada, sin necesidad de tratamiento adicional, y sin mostrar progresión de su enfermedad.</p></span>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1551 "Ancho" => 1674 "Tamanyo" => 360334 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Optical coherence tomography and anterior segment imaging: distal end of XEN® protruding the conjunctiva. (B) Optical coherence tomography and anterior segment imaging: XEN® distal end exposure through conjunctiva</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 701 "Ancho" => 755 "Tamanyo" => 53120 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Appositional suture of the distal end of the XEN® to the sclera.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1251 "Ancho" => 755 "Tamanyo" => 166922 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Anterior segment optical coherence tomography: subconjunctival amniotic membrane overlying the XEN®.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of ab interno XEN gelatin stent vs trabeculectomy with mitomycin C: a retrospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Sharpe" 1 => "G. Pham" 2 => "P. Chang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5005/jp-journals-10078-1287" "Revista" => array:6 [ "tituloSerie" => "J Curr Glaucoma Pract." "fecha" => "2020" "volumen" => "14" "paginaInicial" => "87" "paginaFinal" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33867756" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "XEN glaucoma implant with mitomycin C 1-year follow-up: result and complications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Galal" 1 => "A. Bilgic" 2 => "R. Eltanamly" 3 => "A. Osman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "J Ophthalmol." "fecha" => "2017" "volumen" => "2017" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy, safety, and risk factors for failure of standalone ab interno gelatin microstent implantation versus standalone trabeculectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.B. Schlenker" 1 => "H. Gulamhusein" 2 => "I. Conrad-Hengerer" 3 => "A. Somers" 4 => "M. Lenzhofer" 5 => "I. Stalmans" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ophtha.2017.05.004" "Revista" => array:6 [ "tituloSerie" => "Ophthalmology" "fecha" => "2017" "volumen" => "124" "paginaInicial" => "1579" "paginaFinal" => "1588" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28601250" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "XEN implant in primary and secondary open-angle glaucoma: a 12-month retrospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Ibáñez-Muñoz" 1 => "V. Santiago Soto-Biforcos" 2 => "L. Rodríguez-Vicente" 3 => "I. Ortega-Renedo" 4 => "M. Chacón-González" 5 => "O. Rúa-Galisteo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/1120672119845226" "Revista" => array:6 [ "tituloSerie" => "Eur J Ophthalmol." "fecha" => "2020" "volumen" => "30" "paginaInicial" => "1034" "paginaFinal" => "1041" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31018685" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extrusion and breakage of XEN gel stent resulting in endophthalmitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Lapira" 1 => "N. Cronbach" 2 => "A. Shaikh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/IJG.0000000000001058" "Revista" => array:6 [ "tituloSerie" => "J Glaucoma" "fecha" => "2018" "volumen" => "27" "paginaInicial" => "934" "paginaFinal" => "935" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30113510" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Managing drawbacks in unconventional successful glaucoma surgery: a case report of stent exposure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Fea" 1 => "P.M. Loredana Cannizzo" 2 => "G. Consolandi" 3 => "C.A. Lavia" 4 => "G. Pignata" 5 => "F.M. Grignolo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Case Rep Ophthalmol Med." "fecha" => "2015" "volumen" => "2015" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of conjunctival perforation and late Seidel after XEN® surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Á. Olate-Pérez" 1 => "V.T. Pérez-Torregrosa" 2 => "A. Gargallo-Benedicto" 3 => "R. Escudero-Igualada" 4 => "M. Cerdà-Ibáñez" 5 => "A. Barreiro-Rego" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.oftal.2017.10.002" "Revista" => array:6 [ "tituloSerie" => "Arch Soc Esp Oftalmol." "fecha" => "2018" "volumen" => "93" "paginaInicial" => "93" "paginaFinal" => "96" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29224970" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recurrent exposure of XEN gel stent implant and conjunctival erosion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Arnould" 1 => "V. Theillac" 2 => "S. Moran" 3 => "D. Gatinel" 4 => "A. Grise-Dulac" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/IJG.0000000000001146" "Revista" => array:7 [ "tituloSerie" => "J Glaucoma" "fecha" => "2019" "volumen" => "28" "paginaInicial" => "e37" "paginaFinal" => "e40" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30676470" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0954611113002229" "estado" => "S300" "issn" => "09546111" ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of conjunctival perforation and XEN gel stent exposure by stent repositioning through the anterior chamber" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.F. Santamaría-Álvarez" 1 => "J. Lillo-Sopena" 2 => "S. Sanz-Moreno" 3 => "J.M. Caminal-Mitjana" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/IJG.0000000000001109" "Revista" => array:6 [ "tituloSerie" => "J Glaucoma" "fecha" => "2019" "volumen" => "28" "paginaInicial" => "e24" "paginaFinal" => "e26" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30312285" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009800000006/v1_202306011103/S2173579423000683/v1_202306011103/en/main.assets" "Apartado" => array:4 [ "identificador" => "8724" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Short communication" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009800000006/v1_202306011103/S2173579423000683/v1_202306011103/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579423000683?idApp=UINPBA00004N" ]
