Prominent lymphatic vessel in a functioning bleb after repeat XEN gel stent implantation surgery in pseudoexfoliative glaucoma: a case report

Abstract

XEN gel stent implantation (XEN) surgery is becoming more popular due to its safety profile and efficacy, with conjunctival lymphatics thought to be critical in maintaining bleb drainage. We are reporting the case of a 75-year-old man with right eye pseudoexfoliative glaucoma who had two previous episodes of failed XEN surgery despite given needling and antimetabolite. He had a repeat XEN surgery in our center and his intraocular pressure was under control at the time of writing without any topical glaucoma medication, needling, nor antimetabolite. On examination, there was presence of prominent, dilated, and irregular lymphatic vessel originating from the distal end of the bleb. Anterior segment optical coherence tomography identified the lymphatic vessel located in the superficial Tenon’s layer, which is most likely an initial lymphatic but larger in diameter. This dilated lymphatic vessel may be an important factor for his currently successful filtration surgery.