How to Rescue of the Dislocated XEN® Gel Stent: A New Surgical Approach on XEN Dislocation and Narrative Review

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Abstract
Purpose: To introduce a novel surgical technique for repositioning a dislocated XEN63® gel stent in patients with open-angle glaucoma, to synthesize contemporary findings on complications associated with stent dislocation, and to comment on related management strategies. Methods: A 75-year-old male with primary open-angle glaucoma experiencing XEN63 dislocation underwent this new surgical procedure. Key steps included identifying the scleral leakage site with Trypan Blue, performing precise scleral incisions, and careful stent repositioning. A mini-review on XEN dislocation was conducted through literature searches using PubMed, Embase, Medline, Web of Science, and Google Scholar, focusing on causes, complications, and management strategies. Relevant studies were selected based on specific inclusion criteria and a consensus process involving multiple reviewers. Results: The technique successfully repositioned the stent, with postoperative recovery indicating normal intraocular pressure and correct stent positioning. Initial postsurgery assessments confirmed stent functionality and correct placement. Pathophysiological mechanisms related to dislocation, type of dislocation, and relative management was also presented summarizing the findings based on current literature. Conclusions: The study presents an effective, conservative management method for repositioning dislocated XEN63 gel stents using an ab externo approach. This technique offers a less traumatic alternative to current practices by avoiding the need for additional devices or scleral pocket creation. The accompanying mini-review provides a comprehensive overview of XEN dislocation, enhancing the strategy for managing such complications. Further research, including broader case series or comparative studies, is essential to solidify these findings.

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