Advertisement

XEN Gel Stent: The Solution Designed by AqueSys®

  • Vanessa I. VeraEmail author
  • Christopher Horvath
Chapter

Abstract

XEN Gel Stent is the solution developed by AqueSys, Inc. by merging together the best of both worlds: a long time proven outflow mechanism of action at the subconjunctival space with a minimally invasive approach creating Minimally Invasive Maximum Efficacy technology (MIME).

A detailed explanation of the rationale and calculations are given to allow the reader to get a complete comprehension of the science behind the XEN Gel Stent.

The surgical technique is summarized in 10 simple steps with images and videos from real surgery and animations.

Results from international studies showed a reduction of 38 % of the mean IOP at 24 months and a reduction of 48 % of medications at 24 months from best medicated IOP. One hundred and eighteen patients were enrolled in the study with a mean preoperative IOP of 23 mmHg (non-washed-out IOP value). At postoperative, the mean IOPs were 15.4 at 12 months, 14.5 at 18 months, and 14.3 at 24 months. The mean decrease in IOP (mmHg) was −7.6 (−33 % reduction) at 12 months and −8.5 (−37 % reduction) at 18 months from best medicated IOP.

Keywords

Optical Coherence Tomography Anterior Chamber Aqueous Humor Anterior Segment Optical Coherence Tomography Postoperative IOPs 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 17.1

New animation (MOV 19646 kb)

Video 17.2

Life surgical procedure (MOV 77170 kb)

References

  1. 1.
    Watson PG, Jakeman C, Ozturk M, Barnett MF, Barnett F, Khaw KT. Complications of trabeculectomy (a 20-year follow-up). Eye (Lond). 1990;4:425–38.CrossRefGoogle Scholar
  2. 2.
    Nouri-Mahdavi K, Brigatti L, Weitzman M, Caprioli J. Outcomes of trabeculectomy for primary open-angle glaucoma. Ophthalmology. 1995;102:1760–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Ticho U, Ophir A. Late complications after glaucoma filtering surgery with adjunctive 5-fluorouracil. Am J Ophthalmol. 1993;115:506–10.PubMedGoogle Scholar
  4. 4.
    Costa VP, Wilson RP, Moster M, Schmidt CM, Gandham S. Hypotony maculopathy following the use of topical mitomycin C in glaucoma filtration surgery. Ophthalmic Surg. 1993;24:389–94.PubMedGoogle Scholar
  5. 5.
    Topouzis F, Coleman AL, Choplin N, Bethlem MM, Hill R, Yu F, Panek WC, Wilson MR. Follow-up of the original cohort with the Ahmed glaucoma valve implant. Am J Ophthalmol. 1999;128:198–204.PubMedCrossRefGoogle Scholar
  6. 6.
    Smith SL, Starita RJ, Fellman RL, Lynn JR. Early clinical experience with the Baerveldt 350-mm glaucoma implant and associated extraocular muscle imbalance. Ophthalmology. 1993;100:914–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Topouzis F, Yu F, Coleman AL. Factors associated with elevated rates of adverse outcome after cyclodestructive procedures versus drainage device procedures. Ophthalmology. 1998;105:2276–81.PubMedCrossRefGoogle Scholar
  8. 8.
    Singh D. Conjunctiva lymphatic system. J Cataract Refract Surg. 2003;29:632–3.PubMedCrossRefGoogle Scholar
  9. 9.
    Yucel YH, Johnston MG, Ly T, et al. Identification of lymphatics in the ciliary body of the human eye: a novel “uveolymphatic” outflow pathway. Exp Eye Res. 2009;89:810–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Yu D-Y, et al. The critical role of the conjunctiva in glaucoma filtration surgery. Prog Retin Eye Res. 2009;28:303–28.PubMedCrossRefGoogle Scholar
  11. 11.
    Schmid-Schonbein GW. Microlymphatics and lymph flow. Physiol Rev. 1990;70:987–1028.PubMedGoogle Scholar
  12. 12.
    Singh M, Aung T, Tun TA, et al. Quantitative analysis of the change in bleb morphology over time after successful trabeculectomy [abstract]. Invest Ophthalmol Vis Sci. 2009;50:E-abstract 3370.Google Scholar
  13. 13.
    Theelen T, et al. A pilot study on slit lamp-adapted optical coherence tomography imaging of trabeculectomy filtering blebs. Graefes Arch Clin Exp Ophthalmol. 2007;245:877–82.PubMedCrossRefGoogle Scholar
  14. 14.
    Addicks EM, Quigley HA, Green WR, et al. Histologic characteristics of filtering blebs in glaucomatous eyes. Arch Ophthalmol. 1983;101:795–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Labbé A, Dupas B, Hamard P, Baudouin C. In vivo confocal microscopy study of blebs after filtering surgery. Ophthalmology. 2005;112:1979–86.PubMedCrossRefGoogle Scholar
  16. 16.
    Guthoff R, Klink T, Schlunck G, Grehn F. In vivo confocal microscopy of failing and functioning filtering blebs: results and clinical correlations. J Glaucoma. 2006;15:552–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Messer EM, Zapp DM, Mackert MJ, et al. In vivo confocal microscopy of filtering blebs after trabeculectomy. Arch Ophthalmol. 2006;124:1095–103.CrossRefGoogle Scholar
  18. 18.
    Schmitt JM, Knüttel K, Yadlowsky M, Eckhaus MA. Optical-coherence tomography of a dense tissue: statistics of attenuation and backscattering. Phys Med Biol. 1994;39:1705–20.PubMedCrossRefGoogle Scholar
  19. 19.
    Picht G, Grehn F. Sickekissenentwicklung nach trabekulektomien. Ophthalmologe. 1998;95:380–7.CrossRefGoogle Scholar
  20. 20.
    Singh M, Chew PTK, Friedman DS, et al. Imaging of trabeculectomy blebs using anterior segment optical coherence tomography. Ophthalmology. 2007;114:47–53.PubMedCrossRefGoogle Scholar
  21. 21.
    Teng CC, Chi HH, Katzin HM. Histology and mechanism of filtering operations. Am J Ophthalmol. 1959;47:16–33.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Unidad Oftalmologica De CaracasCaracasVenezuela
  2. 2.AqueSys, IncAliso ViejoUSA

Personalised recommendations