A Case Report: Endophthalmitis after Implantation of XEN® Glaucoma Stent

Author(s): Ahmed Galal, Monika Sajduk-Yilmaz, Rasha Eltanamly, Amr Osman

Purpose: To report a case of endophthalmitis after XEN® 45 stent implantation for managing primary open angle glaucoma (POAG) intolerant to topical therapy.

 

Patient and Methods: A patient with POAG underwent bilateral, non-simultaneous XEN® stent implantation and developed an early-onset endophthalmitis secondary to Staphylococcus epidermidis in one eye.

 

Results: Four days after XEN® implantation in the second eye, the patient developed anterior chamber reaction in form of fibrin and hypopyon, which was handled initially with topical therapy, including fortified antibiotic eye drops. With worsening findings, on postoperative day 6, antibiotics were administered by means of intracameral lavage and subconjunctival injection. Subsequently, vitritis was diagnosed on postoperative day 9 and a pars plana vitrectomy with intravitreal administration of clindamycin and vancomycin was performed together with XEN® stent explantation, followed by an intensive topical treatment. Clinical improvement was achieved after 46 days. At the 12-month follow-up visit, the affected eye had a best-corrected visual acuity of 0.7 Snellen decimal value and the intraocular pressure (IOP) remained above target in both eyes and was again controlled with anti-glaucoma drops bilaterally.

Conclusions: The XEN® stent is an ab interno MIGS approach to subconjunctival outflow, and is not exempt from risk of severe complications including endophthalmitis.

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