Yvonne Ou, MD. The XEN Gel Stent is made of porcine gelatin material, and measures 6 mm long. The Xen Gel stent is as fine as a single stand of human hair. Intro In glaucoma, the pressure in your eye is too high, which damages the delicate optic nerve transmitting information from your eyes to your brain. Seibold LK, Gamett KM, Kennedy JB, et al. Cited Here [12]. This article explores the risks, benefits, and potential complications of tube shunt surgery as a treatment for glaucoma. As with other MIGS procedures, iStent combined with cataract surgery typically lowers eye pressure to the mid-teens. Micro-invasive or minimally invasive glaucoma surgery (MIGS) refers to a group of newer surgical procedures that are performed via an ab interno approach and involve minimal trauma to ocular tissues. : Efficacy and safety of combined cataract surgery with 2 trabecular microbypass stents versus ab interno trabeculotomy.J Cataract Refract Surg 2015;41:1716-1724. cataract surgery. Eyes with mild-to-moderate glaucoma with an unmedicated IOP of 22 mm Hg or higher and 36 mm Hg or lower were randomly assigned to have cataract surgery with iStent trabecular micro-bypass stent implantation (stent group) or cataract surgery alone (control group). The study included 240 eyes with mild to moderate glaucoma, which were randomly assigned to cataract surgery and stent implantation or cataract surgery alone. The primary efficacy measure was unmedicated IOP ≤21 mmHg at one year. Glaucoma is pressure inside your eye , like a basketball being overinflated. There is a certain learning curve involved, however in general the devices are straight forward to insert, earning their acronym MIGS or microinvasive glaucoma surgery. But this is not always the case. It creates a new pathway for fluid inside the eye to drain out of the eye, thereby relieving pressure. It did heal, but my sight is very bad. There are also newer procedures known as minimally invasive glaucoma surgery (MIGS) that hold promise at treating glaucoma. One area in ophthalmology that’s currently seeing a lot of innovation is implantable devices designed to reduce intraocular pressure in glaucoma patients, with an emphasis on minimally invasive, ab interno procedures that can be combined with cataract surgery. XEN glaucoma implant with mitomycin C 1-year follow-up: result and complications. If the second stent is under-implanted, the surgeon can rethread the stent and use the standard amount of pressure to dimple the TM. The stent facilitates intraocular pressure lowering thereby potentially either minimising glaucoma medication, or giving better intraocular pressure control in patients who are poorly controlled. It is a surgical titanium micro-bypass stent that’s preloaded into a sterile inserter, which helps eye surgeon implant the iStent with precision. Cataract surgery and glaucoma shunt procedures. 2018;256(4):765–71. The authors established two main outcomes. The iStent is made of titanium and is a tube-like device only 1 mm in length with a microscopic opening of only 120 microns in diameter. Samuelson TW, Katz LJ, Wells JM, et al. Surgery isn’t usually the first step to treat glaucoma, but it may save your eyesight if other treatments don’t work. 2017;2017:5457246. Although often seen as an adjunct to cataract surgery, a growing body of evidence suggests that primary minimally invasive glaucoma surgery may be a viable initial treatment option. Current glaucoma treatment options are focused on lowering intraocular pressure (IOP), with the ultimate goal of … J Ophthalmol. Cited Here [13]. ↑ Galal A, Bilgic A, Eltanamly R, et al. This surgery lowers the fluid pressure within the eye to lessen the likelihood of pressure damage to the optic nerve, which sends vision from the eye to the brain. These procedures use tiny incisions to place microscopic devices inside the eye to lower the pressure inside the eye. Types of glaucoma surgery. To help lower your eye pressure, he or she will also put a tiny, plastic tube called a shunt under the thin, clear membrane covering the white of your eye. In contrast to traditional glaucoma surgery, implantation of the XEN gel stent is quicker, easier to perform, with less risk of complications. The pressure control achieved is similar to that of standard trabeculectomy. The list of new options for managing glaucoma keeps growing, and stents designed to aid outflow are high on the list. There are many types of glaucoma surgery, with new surgical treatments being developed and perfected all the time. These stenting/shunting procedures are similar to viscocanalostomy in that they lower IOP without the formation of a filtering bleb. Channels: Glaucoma | Posted 12/11/2020 This video demonstrates the combination of viscodilating the canal and stenting for patients with open-angle glaucoma undergoing cataract surgery. What does XEN stent involve? Int Ophthalmol. The Xen Gel stent is a very fine flexible stent made of a porcine gelatin material. Sometimes, surgery can eliminate the need for glaucoma eye drops. Xen Gel Stent is a form of Minimally Invasive Glaucoma Surgery. Prior incisional glaucoma surgery, canal-based surgery, suprachoroidal space-based surgery (trabeculectomy, viscocanalostomy, canaloplasty, shunts of any type, collagen implants, etc.) It never did return. I continued to ask when my sight would return and was continually told, 3-4 weeks. When glaucoma medicines and laser treatment fail or cannot be used to manage glaucoma, Xen is recommended for some patients. In recent years, a new class of treatment called ‘minimally invasive glaucoma surgery’ or ‘MIGS’ is changing the glaucoma treatment model. The iStent® Trabecular Micro-Bypass Stent (Models GTS100R and GTS100L) is indicated for use in conjunction with cataract surgery for the reduction of intraocular pressure (IOP) in adult patients with mild to moderate open-angle glaucoma currently treated with ocular hypotensive medication. 0191T3 Yes èRequires performance in conjunction with cataract extraction. Learn about the Ahmed valve and other tube shunt surgeries. Here, surgeons share their thoughts and experience with three new implant devices under investigation: the CyPass Micro-Stent; … Cataract surgery with trabecular micro-bypass stent implantation in patients with mild-to-moderate open-angle glaucoma and cataract: Two-year follow-up. A 6-mm long hydrophilic gelatin tube with a 45 μm internal diameter (designed using the Hagen-Poiseuille equation ), the stent serves as a channel to drain aqueous fluid from the anterior chamber to the subconjunctival space. iStent eye surgery: how is the iStent eye surgery performed? èA minimally invasive stand-alone procedure for mild, moderate, and severe stages of open angle glaucoma patients. Prior to my surgery, other than high pressure, my sight was wonderful. Three Stents in the Glaucoma Pipeline The goal of increasing controlled aqueous outflow continues to drive new innovations in glaucoma surgery. Khan M und Saheb H et al. Saheb H und Ahmed II: Micro-invasive glaucoma surgery: current perspective and future directions. CONTRAINDICATIONS. It is inert and will remain permanently in the eye. Glaucoma is a leading cause of visual disability and irreversible blindness that affects approximately 70 million people worldwide [1, 2]. Eye stents can help people with glaucoma. To this day I don't really know why my sight is so mad. Curr Opin Ophthalmol 2012; 23: 96 – 104. High pressure can sometimes be treated with eye drops, but they have to be used for all your life and might not get the pressure low enough to be safe for your eye. An ophthalmologist will assess your individual condition and help you decide which option is best for you. Outcomes after combined phacoemulsification and trabecular microbypass stent implantation in controlled open-angle glaucoma. University of California, San Francisco, UCSF Medical Center. Glaucoma Surgery Series: Tube Shunt Drainage Devices. Introduction. iStent Glaukos Stent creates bypass of aqueous through the trabecular meshwork from the anterior chamber into the Canal of Schlemm. The XEN45 gel stent as a minimally invasive procedure in glaucoma surgery: success rates, risk profile, and rates of re-surgery after 261 surgeries. Randomized evaluation of … The newest generation of one type of stent is implanted at the same time a person has cataract surgery. My Dr. told me it would take 2-3 months to heal. Micro-invasive glaucoma surgery (MIGS) is the latest advance in surgical treatment for glaucoma, which aims to reduce intraocular pressure by either increasing outflow of aqueous humor or reducing its production. Purpose: To evaluate the safety and efficacy of supraciliary stenting following failed glaucoma surgery. The iStent is the first ab interno (from the inside) micro-bypass implant for the treatment of glaucoma. In the event of over-implantation, the surgeon can use microforceps to gently pull out the stent from the canal or from deep in the TM. Having Glaucoma surgery. J Cataract Refract Surg 2016;42:1332–8. As far as the general opinion is concerned, the XEN45 stent brought science to the art of glaucoma surgery by applying the principles of fluid dynamics to its design. Xen Gel Stent Implantation: A Glaucoma Surgery to Lower Eye Pressure. The iStent is the world’s smallest implant, but its effects can be huge: once implanted, the device can help restore normal pressure in the eye. MIGS comprises a group of surgical procedures which share common features. Glaucoma stents are a recent innovation to improve outflow of aqueous from the eye and control intraocular pressure. During this surgery, your ophthalmologist will remove your eye’s cloudy lens and replace it with an artificial one. Hydrus Microstent • Open Angle Glaucoma • Stent Methods: Setting: Moorfields Eye Hospital, London, United Kingdom. ↑ De Gregoria A, Pedrotti E, Russo L, et al. The incidence of adverse events was low in both groups through 24 months … Hence, a new drainage pathway for aqueous humor is created … It forms part of the new trend towards minimally invasive glaucoma surgery (MIGS). Patients were followed for 24 months post-operatively. Cypass. Trabeculectomy involves partial removal of clogged trabecular meshwork with the help of incisions to release the intraocular pressure (IOP). Graefes Arch Clin Exp Ophthalmol Albrecht Von Graefes Arch Klin Exp Ophthalmol. Here, three surgeons who have experience using four different stents currently in the pipeline share their experience. A secondary measure was unmedicated IOP reduction≥20 % at one year. Ophthalmol Ther 2016;5:135–46. Keywords: Cataract, iStent Inject, Glaucoma, Micro-invasive glaucoma surgery (MIGS), Stent, Trabecular micro-bypass. Journal of Cataract & Refractive Surgery, 38(8), 1339–1345. Study population: Twenty eyes from 20 patients with glaucoma refractory to prior glaucoma surgery. iStent Inject; Hydrus; XEN Gel Stent In 2018, the manufacturer of the CyPass® micro-stent to treat glaucoma decided to voluntarily withdraw it from the market. The new era of glaucoma micro-stent surgery. These include Trabectome, iStent and CyPass Micro-Stent. 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