{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T10:47:07Z","timestamp":1779360427601,"version":"3.51.4"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T00:00:00Z","timestamp":1724976000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T00:00:00Z","timestamp":1724976000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Ophthalmol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>To assess the efficacy of a gelatin stent (XEN 45 Gel Stent; Allergan) implant in advanced glaucoma eyes that have failed prior aqueous shunt implantation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We retrospectively reviewed 6 patients with refractory glaucoma, defined as persistently high IOP (&gt;\u200921 mmHg) despite taking at least 3 IOP-lowering medications subsequent to undergoing a glaucoma drainage device (GDD) with or without a second GDD or cilioablative procedure. Eyes with previous failed GDD underwent subconjunctival 0.3\u00a0cc (0.4\u00a0mg\/ml) mitomycin C, tenonectomy, and placement of an ab- externo XEN stent. The outcome measures included change in IOP and the number of glaucoma medications. Success was defined as patients achieving an IOP\u2009\u2264\u200918 mmHg with a percentage reduction of 25% or 15 mmHg and 40% mean IOP reduction from baseline while taking the same number or fewer medications.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>All six eyes with age of 77.6\u2009\u00b1\u20097.82 years who underwent XEN implantation following previous GDD surgery had primary open-angle glaucoma. The IOP decreased significantly from 32.33\u2009\u00b1\u20095.99 to 12.67\u2009\u00b1\u20093.27 mmHg (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) with a follow-up of 13.9\u2009\u00b1\u20092 (11.7\u201316.7) months. Visual acuity and visual field remained stable after XEN placement. Compared to the baseline number of medications of 4.2\u2009\u00b1\u20090.8, all medication was discontinued except in one eye on two drops at the end of the follow-up. The overall surgical success rate was 100%. No complications, needling, or additional procedures were required.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>This study described successful implantation of the XEN stent following failed GDD. XEN Gel stent implantation associated with mitomycin C and tenonectomy can be considered a viable surgical option for patients with a history of previously failed tube shunt requiring further IOP lowering.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12886-024-03648-7","type":"journal-article","created":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T14:02:42Z","timestamp":1725026562000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Ab-Externo XEN Gel stent implantation effectively treated refractory glaucoma with prior failed shunt tube"],"prefix":"10.1186","volume":"24","author":[{"given":"Anny M.S.","family":"Cheng","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shailesh K.","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geetha G.","family":"Vedula","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jackson","family":"Saddemi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rita","family":"Vartanian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David T.Y.","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aarup A.","family":"Kubal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,8,30]]},"reference":[{"key":"3648_CR1","doi-asserted-by":"publisher","first-page":"e0162229","DOI":"10.1371\/journal.pone.0162229","volume":"11","author":"RRA Bourne","year":"2016","unstructured":"Bourne RRA, Taylor HR, Flaxman SR, et al. Number of People Blind or visually impaired by Glaucoma Worldwide and in World regions 1990\u20132010: a Meta-analysis. PLoS ONE. 2016;11:e0162229. https:\/\/doi.org\/10.1371\/journal.pone.0162229.","journal-title":"PLoS ONE"},{"key":"3648_CR2","doi-asserted-by":"publisher","first-page":"38","DOI":"10.2174\/1874364100903020038","volume":"3","author":"AL Coleman","year":"2009","unstructured":"Coleman AL, Kodjebacheva G. Risk factors for glaucoma needing more attention. Open Ophthalmol J. 2009;3:38\u201342. https:\/\/doi.org\/10.2174\/1874364100903020038.","journal-title":"Open Ophthalmol J"},{"key":"3648_CR3","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1016\/j.ajo.2011.10.024","volume":"153","author":"SJ Gedde","year":"2012","unstructured":"Gedde SJ, Herndon LW, Brandt JD, et al. Postoperative complications in the Tube Versus Trabeculectomy (TVT) study during five years of follow-up. Am J Ophthalmol. 2012;153:804\u2013e8141. https:\/\/doi.org\/10.1016\/j.ajo.2011.10.024.","journal-title":"Am J Ophthalmol"},{"key":"3648_CR4","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1097\/00055735-199404000-00013","volume":"5","author":"PA Sidoti","year":"1994","unstructured":"Sidoti PA, Baerveldt G. Glaucoma drainage implants. Curr Opin Ophthalmol. 1994;5:85\u201398. https:\/\/doi.org\/10.1097\/00055735-199404000-00013.","journal-title":"Curr Opin Ophthalmol"},{"key":"3648_CR5","doi-asserted-by":"publisher","first-page":"1318","DOI":"10.18240\/ijo.2020.08.20","volume":"13","author":"P Agrawal","year":"2020","unstructured":"Agrawal P, Bhardwaj P. Glaucoma drainage implants. Int J Ophthalmol. 2020;13:1318\u201328. https:\/\/doi.org\/10.18240\/ijo.2020.08.20.","journal-title":"Int J Ophthalmol"},{"key":"3648_CR6","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1016\/j.ajo.2011.10.026","volume":"153","author":"SJ Gedde","year":"2012","unstructured":"Gedde SJ, Schiffman JC, Feuer WJ, et al. Treatment outcomes in the Tube Versus Trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol. 2012;153:789\u2013e8032. https:\/\/doi.org\/10.1016\/j.ajo.2011.10.026.","journal-title":"Am J Ophthalmol"},{"key":"3648_CR7","doi-asserted-by":"publisher","first-page":"3202","DOI":"10.1038\/s41433-021-01595-x","volume":"35","author":"ICF Pereira","year":"2021","unstructured":"Pereira ICF, van de Wijdeven R, Wyss HM, et al. Conventional glaucoma implants and the new MIGS devices: a comprehensive review of current options and future directions. Eye. 2021;35:3202\u201321. https:\/\/doi.org\/10.1038\/s41433-021-01595-x.","journal-title":"Eye"},{"key":"3648_CR8","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1016\/j.ogla.2021.10.011","volume":"5","author":"ER Craven","year":"2022","unstructured":"Craven ER, Singh IP, Yu TM, et al. Reoperation Rates and Disease Costs for Primary Open-Angle Glaucoma Patients in the United States treated with Incisional Glaucoma surgery. Ophthalmol Glaucoma. 2022;5:297\u2013305. https:\/\/doi.org\/10.1016\/j.ogla.2021.10.011.","journal-title":"Ophthalmol Glaucoma"},{"key":"3648_CR9","doi-asserted-by":"publisher","first-page":"e37","DOI":"10.1016\/j.jfo.2018.12.002","volume":"42","author":"J Buffault","year":"2019","unstructured":"Buffault J, Baudouin C, Labb\u00e9 A. XEN\u00ae Gel Stent for management of chronic open angle glaucoma: a review of the literature. J Fr Ophtalmol. 2019;42:e37\u201346. https:\/\/doi.org\/10.1016\/j.jfo.2018.12.002.","journal-title":"J Fr Ophtalmol"},{"key":"3648_CR10","doi-asserted-by":"publisher","first-page":"773","DOI":"10.2147\/OPTH.S146919","volume":"12","author":"A De Gregorio","year":"2018","unstructured":"De Gregorio A, Pedrotti E, Stevan G, et al. XEN glaucoma treatment system in the management of refractory glaucomas: a short review on trial data and potential role in clinical practice. Clin Ophthalmol. 2018;12:773\u201382. https:\/\/doi.org\/10.2147\/OPTH.S146919.","journal-title":"Clin Ophthalmol"},{"key":"3648_CR11","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1097\/ICU.0000000000000462","volume":"29","author":"W Green","year":"2018","unstructured":"Green W, Lind JT, Sheybani A. Review of the Xen Gel Stent and InnFocus MicroShunt. Curr Opin Ophthalmol. 2018;29:162\u201370. https:\/\/doi.org\/10.1097\/ICU.0000000000000462.","journal-title":"Curr Opin Ophthalmol"},{"key":"3648_CR12","doi-asserted-by":"publisher","first-page":"e691","DOI":"10.1097\/IJG.0000000000000352","volume":"25","author":"A Sheybani","year":"2016","unstructured":"Sheybani A, Dick HB, Ahmed IIK. Early clinical results of a novel ab interno gel stent for the Surgical treatment of open-angle Glaucoma. J Glaucoma. 2016;25:e691\u20136. https:\/\/doi.org\/10.1097\/IJG.0000000000000352.","journal-title":"J Glaucoma"},{"key":"3648_CR13","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1007\/s00417-022-05857-6","volume":"261","author":"LK To","year":"2023","unstructured":"To LK, Dhoot RK, Chuang AZ, et al. Defining the role of ab externo xen gel stent in glaucomatous eyes with prior failed surgical intervention. Graefe\u2019s Archive Clin Experimental Ophthalmol. 2023;261:779\u201389. https:\/\/doi.org\/10.1007\/s00417-022-05857-6.","journal-title":"Graefe\u2019s Archive Clin Experimental Ophthalmol"},{"key":"3648_CR14","doi-asserted-by":"publisher","first-page":"192","DOI":"10.5005\/jp-journals-10078-1371","volume":"16","author":"MC Yang","year":"2023","unstructured":"Yang MC, Amoozadeh SA, Lin KY. A case of Refractory Open-angle Glaucoma with failed baerveldt Glaucoma Implant and Trabeculectomy Treated with ab externo XEN Gel Stent Placement. J Curr Glaucoma Pract. 2023;16:192\u20134. https:\/\/doi.org\/10.5005\/jp-journals-10078-1371.","journal-title":"J Curr Glaucoma Pract"},{"key":"3648_CR15","doi-asserted-by":"publisher","unstructured":"Lewczuk K, Konopi\u0144ska J, Jab\u0142o\u0144ska J, et al. XEN Glaucoma Implant for the management of Glaucoma in Na\u00efve patients versus patients with previous Glaucoma surgery. J Clin Med. 2021;10. https:\/\/doi.org\/10.3390\/jcm10194417.","DOI":"10.3390\/jcm10194417"},{"key":"3648_CR16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1136\/bjophthalmol-2023-egsguidelines","volume":"107","author":"L Abegao Pinto","year":"2023","unstructured":"Abegao Pinto L, Sunaric M\u00e9gevand G, Stalmans I, et al. European Glaucoma Society - A guide on surgical innovation for glaucoma. Br J Ophthalmol. 2023;107:1\u2013114. https:\/\/doi.org\/10.1136\/bjophthalmol-2023-egsguidelines.","journal-title":"Br J Ophthalmol"},{"key":"3648_CR17","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1097\/ICU.0000000000000928","volume":"34","author":"SJ Gedde","year":"2023","unstructured":"Gedde SJ, Vinod K, Prum BE, Primary Tube Versus Trabeculectomy Study Group. Results from the primary tube Versus Trabeculectomy Study and translation to clinical practice. Curr Opin Ophthalmol. 2023;34:129\u201337. https:\/\/doi.org\/10.1097\/ICU.0000000000000928.","journal-title":"Curr Opin Ophthalmol"},{"key":"3648_CR18","doi-asserted-by":"publisher","first-page":"1639","DOI":"10.1001\/archopht.118.12.1639","volume":"118","author":"AGIS Investigators","year":"2000","unstructured":"Investigators AGIS. The advanced glaucoma intervention study, 6: effect of cataract on visual field and visual acuity. AGIS Investigators Arch Ophthalmol. 2000;118:1639\u201352. https:\/\/doi.org\/10.1001\/archopht.118.12.1639.","journal-title":"AGIS Investigators Arch Ophthalmol"},{"key":"3648_CR19","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1016\/j.jcjo.2022.02.012","volume":"58","author":"A-A Szigiato","year":"2023","unstructured":"Szigiato A-A, Touma S, Jabbour S, et al. Efficacy of ab-interno gelatin microstent implantation in primary and refractory glaucoma. Can J Ophthalmol. 2023;58:328\u201337. https:\/\/doi.org\/10.1016\/j.jcjo.2022.02.012.","journal-title":"Can J Ophthalmol"},{"key":"3648_CR20","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.ajo.2017.07.023","volume":"183","author":"DS Grover","year":"2017","unstructured":"Grover DS, Flynn WJ, Bashford KP, et al. Performance and safety of a New Ab Interno Gelatin Stent in refractory Glaucoma at 12 months. Am J Ophthalmol. 2017;183:25\u201336. https:\/\/doi.org\/10.1016\/j.ajo.2017.07.023.","journal-title":"Am J Ophthalmol"},{"key":"3648_CR21","doi-asserted-by":"publisher","first-page":"3205","DOI":"10.2147\/OPTH.S378038","volume":"16","author":"LKM Xu","year":"2022","unstructured":"Xu LKM, Chan TYB. Ab interno XEN gel stent implantation in eyes with previous tube shunt surgery. Clin Ophthalmol Volume. 2022;16:3205\u201312. https:\/\/doi.org\/10.2147\/OPTH.S378038.","journal-title":"Clin Ophthalmol Volume"},{"key":"3648_CR22","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1111\/ceo.14181","volume":"51","author":"A Vukmirovic","year":"2023","unstructured":"Vukmirovic A, Ong J, Mukhtar A, et al. Outcomes of 45 \u00b5m gelatin stent surgery over 24-month follow-up. Clin Exp Ophthalmol. 2023;51:19\u201330. https:\/\/doi.org\/10.1111\/ceo.14181.","journal-title":"Clin Exp Ophthalmol"},{"key":"3648_CR23","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1097\/ICU.0b013e3283360b68","volume":"21","author":"SJ Gedde","year":"2010","unstructured":"Gedde SJ, Heuer DK, Parrish RK. Review of results from the Tube Versus Trabeculectomy Study. Curr Opin Ophthalmol. 2010;21:123\u20138. https:\/\/doi.org\/10.1097\/ICU.0b013e3283360b68.","journal-title":"Curr Opin Ophthalmol"},{"key":"3648_CR24","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1016\/j.ajo.2022.02.027","volume":"240","author":"EC Bowden","year":"2022","unstructured":"Bowden EC, Choudhury A, Gedde SJ, et al. Risk factors for failure of tube shunt surgery: a Pooled Data Analysis. Am J Ophthalmol. 2022;240:217\u201324. https:\/\/doi.org\/10.1016\/j.ajo.2022.02.027.","journal-title":"Am J Ophthalmol"},{"key":"3648_CR25","doi-asserted-by":"publisher","first-page":"804847","DOI":"10.3389\/fmed.2022.804847","volume":"9","author":"X-Z Chen","year":"2022","unstructured":"Chen X-Z, Liang Z-Q, Yang K-Y, et al. The outcomes of XEN Gel Stent Implantation: a systematic review and Meta-analysis. Front Med (Lausanne). 2022;9:804847. https:\/\/doi.org\/10.3389\/fmed.2022.804847.","journal-title":"Front Med (Lausanne)"},{"key":"3648_CR26","doi-asserted-by":"publisher","first-page":"e531","DOI":"10.1111\/aos.14605","volume":"99","author":"K Gillmann","year":"2021","unstructured":"Gillmann K, Bravetti GE, Rao HL, et al. Combined and stand-alone XEN 45 gel stent implantation: 3-year outcomes and success predictors. Acta Ophthalmol. 2021;99:e531\u20139. https:\/\/doi.org\/10.1111\/aos.14605.","journal-title":"Acta Ophthalmol"},{"key":"3648_CR27","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1097\/IJG.0000000000001394","volume":"29","author":"N Midha","year":"2020","unstructured":"Midha N, Gillmann K, Chaudhary A, et al. Efficacy of needling Revision after XEN Gel Stent Implantation: a prospective study. J Glaucoma. 2020;29:11\u20134. https:\/\/doi.org\/10.1097\/IJG.0000000000001394.","journal-title":"J Glaucoma"}],"container-title":["BMC Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12886-024-03648-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12886-024-03648-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12886-024-03648-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T14:04:44Z","timestamp":1725026684000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcophthalmol.biomedcentral.com\/articles\/10.1186\/s12886-024-03648-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,30]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["3648"],"URL":"https:\/\/doi.org\/10.1186\/s12886-024-03648-7","relation":{},"ISSN":["1471-2415"],"issn-type":[{"value":"1471-2415","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,30]]},"assertion":[{"value":"27 June 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 August 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 August 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The Broward Hospital District Health Ethics Committee granted the Institutional Review Board\u2019s approval (#2023\u2009\u2212\u2009106) for the protection of human subjects. All research adhered to the principles of the Declaration of Helsinki and the Institutional Review Board determined that informed consent for this retrospective study could be waived.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"None of the authors have conflicts of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"No authors have any proprietary interest in this study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Financial disclosure"}}],"article-number":"384"}}