Stanley Eye Unit, Abergele hospital, Abergele, Conwy, Wales.
J Glaucoma. 2018 Oct;27(10):931-933. doi: 10.1097/IJG.0000000000001012.
XEN45 Gel stents are in their infancy, and clinical expertise with microsurgical glaucoma devices are increasing. The soft flexible nature of the XEN stent together with its malleability under the conjunctival tissue should negate any risk of exposure of the XEN45 stent (XEN). However, we report a case in which sight-threatening endophthalmitis was the presenting feature of this complication.
We present a case of uncomplicated XEN implantation that developed endophthalmitis 4 months after surgery. She gave an 8-day history of diarrhea before presentation. She was noted to have exposure of the XEN stent at the point of entry of the XEN into the subconjunctival space. The stent was removed, pars plana vitrectomy was carried out, and intravitreal antibiotics were administered. Achieving low intraocular pressures, bearing in mind her preservative allergy, became a challenge, as we struggled to manage her advanced glaucoma medically. A CyPass Micro-Stent was subsequently inserted to control the intraocular pressure.
Episodes of XEN stent exposure may not be so isolated. We postulate that poor handwashing transmitted the causative organism to the exposed stent, which then resulted in endopthalmitis. We would like to highlight a few learning points from this case.
XEN45 凝胶支架仍处于起步阶段，而显微外科青光眼器械的临床经验也在不断增加。XEN 支架柔软灵活，在结膜组织下具有延展性，应该可以消除 XEN45 支架（XEN）暴露的任何风险。然而，我们报告了一例以威胁视力的眼内炎为特征的并发症。
我们报告了一例 XEN 植入术后 4 个月发生眼内炎的单纯病例。她在就诊前有 8 天的腹泻病史。我们发现 XEN 进入结膜下空间的部位暴露了 XEN 支架。支架被移除，进行了玻璃体切除术，并给予眼内抗生素治疗。考虑到她对防腐剂过敏，要实现低眼压是一个挑战，因为我们努力通过药物来控制她的晚期青光眼。随后插入了 CyPass 微支架来控制眼压。
XEN 支架暴露的情况可能并非如此孤立。我们推测，手部卫生不佳导致病原体传播到暴露的支架，从而导致眼内炎。我们希望从这个病例中强调几点学习要点。
