PMC9082189_01
Exposed inferior nasal bleb (white arrow).
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PMC9082189_01_cop-0013-0253-g01.jpg
F1
Slit-lamp examination revealed a large hypertrophic inferonasal bleb as well as scarring of a previously formed superior bleb above the Xen Gel Stent implant (Fig. 1).
Intraoperative and post-operative images of a fixation suture for managing inferonasal hypertrophic bleb. a Aspiration of bleb during surgical revision. b Released conjunctiva and Tenon in the superonasal quadrant above the Xen Gel Stent implant with wrong angulation. c Xen Gel Stent fixation suture with Nylon 10-0. d Functional, superiorly positioned bleb 20 months after Xen revision surgery.
cop-0013-0253-g02.jpg
PMC9082189_01_cop-0013-0253-g02.jpg
F2
Under local anaesthesia, fluid was aspirated from the inferior bleb with a 30-gauge needle (Fig. 2a). The conjunctiva and Tenon's layer were then separated to facilitate a two-layer closure. The implant was found to be functional after it had been released from the surrounding fibrosis (Fig. 2b). As the Xen implant was undesirably angled towards the inferior quadrant, a nylon 10-0 fixation suture was used to redirect the drainage of aqueous humour more superiorly (Fig. 2c). Twenty months after the Xen revision surgery, the bleb was still functional, diffuse, and posteriorly directed (Fig. 2d).