Transconjunctival Compression Sutures for an Overfiltering Bleb Following Subconjunctival Gel Stent Insertion for Glaucoma.

Low intraocular pressure and hypotony secondary to overfiltration is a recognized complication after trabeculectomy, particularly when augmented with antimetabolites such as 5-fluorouracil and mitomycin C. The relatively recent introduction of minimally invasive glaucoma surgery such as the ab interno XEN 45 (Allergan, Ireland) subconjunctival gel implant has heralded a new era of glaucoma drainage surgery where postoperative complications may be less and surgical recovery quicker. However, any effective glaucoma filtering procedure will always carry the risk of inducing hypotony. We describe the case of an 84-year-old white gentleman who underwent right eye XEN implantation for refractory primary open-angle glaucoma who subsequently developed persistent hypotony secondary to an overfiltering bleb. The complication was successfully treated with a modified transconjunctival bleb compression suture technique. To our knowledge, this has not been previously described in the literature and may help the glaucoma specialist deal effectively and relatively noninvasively with this rare but potentially challenging minimally invasive glaucoma surgery complication.