Study: Open Conjunctival Approach for Sub-Tenon’s Xen Gel St
A Study was conducted to assess clinical outcomes and bleb morphology following sub-Tenon’s implantation of the Xen Gel Stent.

The medical records of patients who underwent sub-Tenon’s Xen® Gel Stent implantation with intraoperative mitomycin-C via an open conjunctival approach were reviewed. Postoperative intraocular pressure (IOP) and number of glaucoma medications at 1,3,6,9 and 12 months were assessed. Bleb morphology was analyzed at various timepoints using anterior segment OCT.

--26 eyes were included in the study. Mean age was 69.4±8.0 years. Mean preoperative IOP was 28.1±7.8mm Hg on an average of 3.5±0.9 glaucoma medications.

--Mean IOP at postoperative month 12 was 12.9±4.0mm Hg on an average of 0.3±0.6 glaucoma medications.

--3 eyes required postoperative needle revision. Bleb morphology in the early postoperative period was characterized by multiple small subconjunctival microcysts on AS-OCT.

--At the intermediate (6-12 mo) and long-term time points, reduction in microcysts with multiple internal parallel layers of aqueous flow and a uniform pattern were more frequently noted.

--All functional blebs were characterized by the presence of a posterior episcleral fluid lake. Failed blebs showed absence of aqueous humor around the distal end of the microshunt.

Conclusively, following an open conjunctival approach, sub-Tenon’s placement of the Xen® Gel Stent with significant IOP lowering was achieved. In eyes with good shunt function, bleb morphology by AS-OCT showed a posterior episcleral fluid lake similar to findings following trabeculectomy.