Dr. Kavanagh, San Antonio Ophthalmologist, implants the Xen Gel Stent a Micro Invasive Glaucoma Surgery (MIGS) in a novel new approach with the chances of a higher success rate of the original surgical approach.
The Xen Gel Stent is designed to drain aqueous from the anterior chamber to the sub-conjunctival space. They were originally designed for Ab Interno use, meaning implanting from the inside of the eye to the subconjunctival space. However, the failure rates of the surgery were recorded as high as 40%, these were cases that needed further surgical intervention like needling of the bleb. It was thought this rate was so high as the device was implanted in the sub-tenon space, where more fibrosis occurs.
A new approach has been described where the Xen is implanted through the conjunctiva (Ab Externo) approximately 7mm from the surgical limbus. This technique allows the Xen to be placed above Tenon’s capsule until it enters the anterior chamber, allowing for less bleb encapsulation/failures. The anterior chamber is entered approximately 1.5mm from the surgical limbus by turning the device into the anterior chamber at this point. The needle is confirmed to be in the correct position before injecting in the XEN stent. I prefer to leave 2-3 mm in the anterior chamber 3-4mm in the subconjunctival space. I inject the MMC (Mitomycin-C) 0.2mg/ml after implantation, guarding the ostium of the Xen to prevent the MMC from entering the anterior chamber.
Dr. Kavanagh practices at Eye Associates of South Texas with offices in Seguin, San Antonio, New Braunfels, Luling, Lockhart, Gonzales, Castroville, and Hondo. 830-379-3937.
Dr. Kavanagh is fellowship-trained in Glaucoma.
Dr. Kavanagh is a board-certified ophthalmologist and clinical assistant professor at University of Texas Health Science Center in San Antonio Texas, where he has taught many residents cataract and glaucoma surgery. Dr. Kavanagh has performed over 20,000 cataract procedures with intraocular lens implantation. He implants Restor, Technis Multi-Focal (MF), Crystalens, Symfony, Toric IOLs.