JONATHAN S. MYERS, MD
Chief, Glaucoma Service
What are the steps of surgery?
The surgery is performed in the operating room. Your eye will be numbed with eye drops and numbing jelly. The anesthesiologist will give you some medications through your IV to keep you relaxed and calm during surgery. The eye is cleaned and the face will be covered with a sterile drape. An instrument opens the eyelids. The Xen is loaded in a specific inserter and is placed at the top part of the eye. One end is inside the eye and the other end is under the conjunctiva. So it drains the fluid form anterior part of the eye to the space under the conjunctiva.
What happens to the eye after surgery?
Once the Xen has been implanted, fluid begins to leave the eye more easily. This escaping fluid raises the conjunctiva (clear membrane covering the white part of the eye) creating a “filtering bleb.” This “bleb” or bubble on the surface of the eye is usually under the upper eyelid and not visible without raising the upper lid. The fluid is reabsorbed from the bleb by the tissues and veins around it. With a successful Xen stent, the fluid pressure within the eye is often lowered for several years. The duration of success depends on the patient’s age, type of glaucoma, and many other factors. Some patients may have an exaggerated healing process and scar formation which may block the Xen stent. It is very important to keep scheduled follow-up appointments to detect early blockage of the stent and receive proper care to keep the Xen working at its best. It is very important that you keep your follow up appointments so your surgical team can monitor the pressure and the healing, watch for complications, and make sure that your eye stays on track for a positive result. The need for glaucoma eye drops is usually reduced if not eliminated after surgery.
What will I feel during and after the surgery?
You may see bright lights during the surgery, but should not feel any pain. You will be discharged with a clear plastic shield over the operated eye. An adult will need to drive you home since you received sedative medications.
How often will I be seen after surgery?
You will see your doctor the first day after surgery, about a week later, and a few weeks after that. Depending on how your eye heals, additional or fewer visits may be needed.
What eye drops will I use after surgery?
Most patients will be asked to use a steroid and antibiotic eye drops. The frequency of the taking the steroid eye drops depend on the amount of the eye inflammation.
Can I stop my glaucoma drops after surgery?
Your doctor will tell you which drops to continue using and how often at each visit depending on how your eye is doing. Sometimes patients are able to reduce the number of eye drops they are taking. Even if you are taking the same glaucoma medications after the procedure, the surgery is a success if your pressure is lower.
Will my vision improve right after surgery?
The first few days after surgery, vision may be blurry and even worse than it was before surgery. This will improve over several weeks, although it can sometimes take longer. The eye that was not operated on will not be affected, and may be depended on for vision during the recovery period (if it has vision).
JONATHAN S. MYERS, MD
L. JAY KATZ, MD
ELIZABETH DALE, MD
SCOTT FUDEMBERG, MD
NATASHA KOLOMEYER, MD
DANIEL LEE, MD
LINDSAY MACHEN, MD
MARLENE R. MOSTER, MD
MICHAEL PRO, MD
REZA RAZEGHINEJAD, MD
AAKRITI GARG SHUKLA, MD
MARY JUDE COX, MD
RACHEL NIKNAM, MD
JODY PILTZ-SEYMOUR, MD
JESSE RICHMAN, MD
GEOFFREY SCHWARTZ, MD
COURTLAND SCHMIDT JR., MD
MONISHA VORA, MD
ALICE WILLIAMS, MD
Xen Gel Stent Implantation: A Glaucoma Surgery to Lower Eye Pressure
When glaucoma medicines and laser treatment fail or cannot be used to manage glaucoma, Xen is recommended for some patients. This surgery lowers the fluid pressure within the eye to lessen the likelihood of pressure damage to the optic nerve, which sends vision from the eye to the brain. Although no surgery can cure glaucoma forever or reverse vision loss, Xen is an effective surgery that can slow or stop the progression of glaucoma by lowering the pressure in your eye. Xen is less invasive compared to traditional glaucoma surgery (trabeculectomy) and has a quicker recovery. Xen drains fluid to the same space as traditional glaucoma surgery, but is less invasive.
How does the Xen work?
The Xen is a small tube (about the length of an eyelash) that is designed to stay in the eye permanently. When it is inserted into the eye it becomes soft and flexible and is rarely seen or felt. The Xen creates a small channel in the eye to drain fluid from the front part of the eye to the space under the conjunctiva, which is a clear membrane covering the white part of the eye. The drained fluid is reabsorbed by the tissues surrounding the eye.
What is the recovery time and what should I expect?
Depending on your job and your other eye, you should be able to return to work within a few days to a few weeks. Limitations in physical activities at work may be needed. After surgery, your eye may be sore, and it may feel like there is something in it, like an eyelash. The drops may burn when you put them in, and your eye may water or tear a lot. These symptoms are common but usually are mild, and improve for most people after 1-2 days. Tylenol (acetaminophen) is a good option unless you are unable to take this medication. If your eye has severe pain or sudden worsening pain or vision after surgery, please call our office or on call physician immediately.
Will I have any restrictions after surgery?
You will be given detailed instructions after your surgery that are specific to your eye’s needs. In general, the following guidelines apply:
- The plastic shield should be worn while sleeping for 2 or more weeks after surgery to protect the eye.
- While outside during the day, sunglasses should be worn to protect the eye from the sun and wind.
- For the first few weeks, avoid strenuous activities (running, lifting more than 10 pounds), bending, rubbing the eye, wearing eye makeup, and swimming.
There are no restrictions in reading, watching TV, using your phone, tablet device, computer, etc but you may tire more easily during these activities.
Will Xen cure my glaucoma?
No. Glaucoma is a chronic disease that requires constant monitoring and treatment. The Xen procedure will help to lower your eye pressure. However, it will not reverse any loss of vision that has already occurred.
What are the possible side effects of Xen surgery?
Possible complications may include, infection, bleeding in the front or back part of the eye, buildup of fluid between the choroid (inner layer of blood vessels) and the sclera (white outer layer of the eyeball), very low eye pressure, implant moving to another part of the eye, implant exposure, wound leak, need for additional surgical intervention, and other eye surgery complications. In some patients, the eye pressure may increase and an additional surgical procedure in the eye to release scar tissue (needling) around the implant may be required.
However, for many patients, the risk of surgery is lower than the risk of losing vision from glaucoma.
What happens if the implant does not work?
In case of early failure, breaking the scar around the Xen and injection of the anti-scar medication around the implant may be required. Long term eye pressure reduction may be not as good as after traditional glaucoma surgery (trabeculectomy); however, it may be sufficient to control your glaucoma. If Xen fails and eye pressure is elevated, the traditional glaucoma surgery (trabeculectomy) or tube shunt surgery can be performed.