Implantation of XEN 63® drainage device in the inferior quadrant in a patient with refractory myopic glaucoma.

INTRODUCTION

Refractory glaucoma are defined as cases that have undergone surgery or cyclophotocoagulation but continue to progress despite maximum pharmacological treatment. The Xen 63® implant is a 6-mm long cylinder with a 63-micron internal diameter used for subconjunctival aqueous humor drainage. It has the versatility to be placed either ab-interno or ab-externo in all 4 conjunctival quadrants.

CLINICAL CASE: A 60-year-old Caucasian woman with amaurosis in her right eye presented with refractory myopic glaucoma in her left eye, having undergone previous trabeculectomy surgery in the superior and inferior quadrants and an Ahmed valve in the superotemporal area. She had a best-corrected visual acuity of 0.5 and a visual field with preservation of less than the central 5 degrees. Intraocular pressure remained above 20mmHg despite maximum pharmacological treatment. Given the risk of glaucomatous progression, Xen 63® surgery was indicated in the inferonasal quadrant.

RESULTS

One year after the procedure, the patient maintains a best-corrected visual acuity of 0.5, a functioning inferior bleb with an avascular inferior zone, intraocular pressure of 9mmHg, and fundus without changes compared to the preoperative control.

CONCLUSIONS

The Xen 63® device allows us to perform filtering surgeries in areas previously less accessible for other filtering surgeries. We describe that inferior nasal implantation is effective in reducing intraocular pressure in cases where the remainder of the conjunctiva or sclera is unapproachable for successful surgery.