Surgeon: Marlene Moster, MD | Year: 2019
Dr. Moster implants a Xen Gel Stent ab externo through a failed trabeculectomy. The conjunctiva is marked 2 mm from the limbus. The injector is tunneled subconjunctivally to the 2 mm mark then directed inferiorly through the sclera into the anterior chamber angle. The stent is deployed into the angle and subconjunctival space while the injector is retracted. The bleb is noted to reform, then lidocaine and mitomycin-C are injected subconjunctivally.
PREOPERATIVE DIAGNOSIS:Glaucoma with failed trabeculectomy, *** eye
PROCEDURE PERFORMED:Xel Gel Stent implantation with mitomycin-C, *** eye
IMPLANT:Xel Gel Stent, serial number ***
ANESTHESIA:MAC, topical, and local
Prior to the date of surgery, the risks, benefits, and alternatives of the planned procedure were discussed with the patient, and informed consent was obtained. The patient was identified in the preoperative area by the attending physician, and the operative eye was marked. The patient was taken to the operative suite and given IV sedation and topical ocular anesthesia. The operative eye was prepped and draped in the usual sterile ophthalmic fashion. A lid speculum was inserted.
A 7-0 Vicryl traction suture was placed in partial-thickness superior cornea. Inferonasal and inferotemporal paracenteses were made into clear cornea. Lidocaine was injected into the anterior chamber. A marked caliper was used to mark 2 mm posterior to the limbus. The eye was distracted inferiorly, and the trabeculectomy flap was identified and outlined.
The superior distal conjunctiva was elevated using smooth forceps. The Xen Gel Stent was marked with a marking pen. The injector was introduced into the superior subconjunctival space, advanced to the 2 mm mark, then directed inferiorly through sclera into the anterior chamber angle. The stent was then deployed into the anterior chamber and subconjunctival space with concurrent retraction of the injector. An appropriate bleb was noted to form over the subconjunctival portion of the stent.
A 1:1 mixture of preservative-free 1% lidocaine and mitomycin-C (0.4 mg/mL) was injected into the subconjunctival space. The traction suture was removed. The corneal incision was hydrated then inspected with a Weck-cel sponge and found to be watertight with good intraocular pressure by finger tension. The speculum and drapes were removed, and antibiotic-steroid drops were placed in the eye. A shield was applied. The patient was then transported to the postoperative care unit in good condition.