70-year-old Professor of Asian ethnicity had a right eye trabeculectomy three years back and with an excellent outcome.
In his left eye he has a standalone Xen by a trainee Doctor, with subconjunctival fibrosis necessitating a peritomy and revision under the care of another Consultant. Post-operatively his pressure remained elevated at 40mmHg and was referred to my care for an opinion. The patient wanted a trabeceulectomy in his left eye: would this be a good option?
The only way this would be a good option, if the scarring was only localised nasally: hence the flap and bleb could be created temporally. However due to the extent of the peritomy, Ophthalmic Surgeon- Gurjeet Jutley offered him Baerveldt tube surgery, https://www.youtube.com/watch?v=g4UZD5alydU.
6 months after his surgery, his pressure remains 17mmHg off drops. He has not required removal of suture.
Learning points: Xen in non Caucasians has a high risk of failure and other techniques should be sought.