Endophthalmitis in XEN45 Gel Stent: Case report and review of the literature.

This is a care of endophthalmitis following XEN45 Gel Stent implantation managed with combined corneal transplant and pars plana vitrectomy, and to review reported cases of endophthalmitis after minimally invasive glaucoma surgery. A 67-year-old male with primary open-angle glaucoma developed endophthalmitis 2 months after XEN45 implantation. Upon referral to our tertiary care center, he underwent urgent implant removal, penetrating keratoplasty with temporary keratoprosthesis, and pars plana vitrectomy with intravitreal antibiotics. Cultures grew Streptococcus gordonii. A second corneal transplant with fresh donor tissue was performed 4 months later. Despite vision limited to light perception, the infection resolved and the eye was preserved. This is the first reported case of XEN45 Gel Stent-associated endophthalmitis which was successfully controlled with combined keratoplasty and vitrectomy. Our review of published cases identified 45 minimally invasive glaucoma surgery-related endophthalmitis cases, with XEN45 accounting for 58%. Potential risk factors included the XEN45 stent's susceptibility to exposure after conjunctival erosion, pool water exposure, and ab externo insertion during implantation. In cases of XEN45 Gel Stent-associated endophthalmitis, corneal transplant with pars plana vitrectomy could be a successful strategy to control infection and spare the globe.