Management of conjunctival perforation and late Seidel after XEN® surgery

Abstract

Clinical case

The case concerns a 78 year-old woman with a history of XEN^® surgery, in whom a conjunctival perforation was observed at the implant level at 18-months of follow-up, for which surgical intervention was decided. During surgery a short subconjunctival portion was found (0.5 mm). An unsuccessful attempt was made to extract it by traction, but the XEN^® broke easily. Finally, it was decided to cut it to scleral level, and suture the conjunctiva. During the first week there was a decrease in intraocular pressure (6 mmHg), to subsequently increase to 25, and deciding to start medical treatment.

Discussion

Conjunctival exposure of the XEN^® stent is a rare but potentially serious complication. To avoid it, a meticulous surgical technique is important when implanting it. If this occurs, it is important to identify the cause. If it is due to a short subconjunctival portion, a therapeutic alternative is to cut the implant at this level to avoid further complications.

Resumen

Caso clínico

Mujer de 78 años con antecedentes de cirugía XEN^®. A los 18 meses de seguimiento se observa perforación conjuntival a nivel del implante, decidiéndose intervención quirúrgica. En esta se constató un trayecto subconjuntival corto (0,5 mm). Se intenta, sin éxito, extraerlo mediante tracción, sin embargo, el XEN^® se rompe con facilidad. Finalmente se decide seccionarlo hasta nivel escleral, y suturar la conjuntiva. Durante la primera semana poscirugía existe disminución de la presión intraocular (6 mmHg), para posteriormente aumentar progresivamente hasta 25, optándose por iniciar tratamiento médico.

Discusión

La exposición conjuntival del XEN^® es una complicación rara, pero potencialmente grave. Para evitarla es importante una técnica quirúrgica meticulosa durante su implantación. En caso de suceder es importante identificar la causa. Si es debida al trayecto subconjuntival corto, una alternativa terapéutica es la sección del implante a este nivel para evitar nuevas complicaciones.