XEN Gel Stent for Moderate-to-Advanced Glaucoma
What Is the XEN Gel Stent and How Does It Work?
When eye drops and laser treatments are no longer enough to control glaucoma, a more targeted surgical approach may be the next step. The XEN Gel Stent is a soft, flexible implant designed to lower intraocular pressure (IOP) by creating a new drainage pathway inside the eye. At Greenwich Ophthalmology Associates, our glaucoma specialists use the XEN Gel Stent to help patients with moderate-to-advanced glaucoma achieve meaningful pressure reduction while preserving as much vision as possible. This procedure offers a less invasive alternative to traditional glaucoma surgery, with a shorter recovery time and a favorable safety profile. If you are managing glaucoma in the greater NY/CT region, understanding how the XEN Gel Stent works can help you make a more informed decision about your care.
The XEN Gel Stent is a tiny, biocompatible implant used in a type of procedure known as minimally invasive glaucoma surgery (MIGS). It works by giving excess fluid inside the eye a new route to drain, which helps lower intraocular pressure.
The XEN Gel Stent is made from a porcine gelatin material that is soft and flexible. It measures about 6 millimeters in length and has an internal lumen of 45 microns, which regulates the flow of aqueous humor (the clear fluid inside the eye) out of the anterior chamber. Because the stent is made from a hydrophilic material, it conforms to the surrounding tissue and is well tolerated by the body over time.
During the procedure, the stent is placed through the wall of the eye so that one end sits in the anterior chamber and the other end rests beneath the conjunctiva (the thin, clear tissue covering the white of the eye). Aqueous humor flows through the stent and collects under the conjunctiva in a small reservoir called a filtering bleb. From there, the fluid is absorbed into surrounding blood vessels, effectively reducing eye pressure.
To keep the drainage pathway open and functioning long term, our glaucoma specialists typically apply mitomycin C (MMC) during the procedure. MMC is an anti-scarring medication that helps prevent the body's natural healing response from closing off the bleb. This step is important for maintaining pressure-lowering results over months and years.
The XEN Gel Stent is placed using an ab interno approach, meaning the surgeon accesses the implantation site from inside the eye through a small corneal incision. This avoids the need for larger external incisions and conjunctival dissection that traditional glaucoma surgeries require. The technique is performed in an operating room under topical or local anesthesia and generally takes less than 30 minutes.
How the XEN Differs from Other MIGS Devices
Not all minimally invasive glaucoma procedures work the same way. Understanding how the XEN Gel Stent differs from other devices helps clarify when it may be the better option.
Most MIGS devices, such as the iStent and Hydrus Microstent, redirect aqueous humor into the eye's natural drainage channel called Schlemm's canal. The XEN Gel Stent takes a different approach by draining fluid into the subconjunctival space, which is the same target used in traditional trabeculectomy surgery. This subconjunctival drainage pathway allows the XEN to achieve a greater degree of pressure reduction than canal-based devices in many cases.
Because of its subconjunctival drainage route, the XEN Gel Stent can lower IOP into the mid-teens for many patients. Canal-based MIGS devices like the Hydrus Microstent tend to achieve more modest pressure reductions. For patients who need their pressure lowered more significantly, the XEN may be a better fit than Schlemm's canal devices.
Many canal-based MIGS devices are FDA-approved only for use during cataract surgery. The XEN Gel Stent can be implanted as a standalone procedure or combined with cataract surgery, making it a more versatile option for patients who do not need cataract removal. For a detailed look at how various devices compare across key factors, our team can walk you through the differences during a consultation.
Who Is a Good Candidate for XEN Implantation?
The XEN Gel Stent is not appropriate for every glaucoma patient. Our glaucoma specialists consider several factors when determining whether this procedure is the right approach for your situation.
The XEN Gel Stent is typically recommended for patients with moderate-to-advanced open-angle glaucoma who need more pressure reduction than eye drops or canal-based MIGS can provide. It is particularly useful when medications are causing significant side effects or when adherence to a complex drop regimen is difficult.
Patients who have already tried glaucoma eye drops, laser treatments such as selective laser trabeculoplasty (SLT), or other interventions without achieving adequate pressure control may benefit from the XEN Gel Stent. The device was originally studied in patients with refractory glaucoma, meaning their condition had not responded sufficiently to prior treatments.
Because the XEN relies on a subconjunctival bleb, the health of the conjunctiva matters. Patients with significant scarring from previous eye surgeries, chronic inflammation, or certain eye surface conditions may not be ideal candidates. Our glaucoma specialists assess the conjunctival tissue during the evaluation to ensure the best possible outcome.
Some patients who would otherwise be candidates for trabeculectomy or tube shunt surgery prefer the XEN Gel Stent because it is less invasive, has a shorter procedure time, and is associated with fewer postoperative complications. While the XEN may not lower pressure to the same degree as trabeculectomy in every case, it offers a meaningful reduction with a more favorable recovery experience. You can learn more about the differences between MIGS and traditional glaucoma surgery to better understand your options.
What to Expect During Recovery After XEN Surgery
Recovery after XEN Gel Stent implantation is generally quicker than after traditional glaucoma surgery. Knowing what to expect during each phase of healing can help you prepare and feel more confident about the process.
Immediately after surgery, you may experience mild discomfort, light sensitivity, and blurred vision. These symptoms are normal and usually improve within the first few days. You will be prescribed anti-inflammatory and antibiotic eye drops to prevent infection and control inflammation during the healing period.
For the first one to two weeks, you should avoid heavy lifting, strenuous exercise, bending at the waist, and swimming. Sleeping on the side of the operated eye should also be avoided during the early recovery phase. Our team will provide specific guidance tailored to your situation.
Frequent follow-up visits are an important part of XEN recovery. You can expect to be seen within the first day or two after surgery, then at regular intervals over the following weeks and months. During these visits, our glaucoma specialists check the bleb, measure your eye pressure, and determine whether any adjustments are needed.
Most patients can return to light daily activities within a few days and resume more strenuous tasks within two to four weeks. Visual recovery varies, but many patients notice improvement within the first week or two. Your eye pressure will continue to be monitored closely over the first several months to confirm the stent is functioning well.
Frequently Asked Questions
Clinical studies have shown that approximately 60 to 80 percent of patients achieve their target pressure after XEN implantation. Many patients are also able to reduce or eliminate their glaucoma medications. The degree of success depends on factors like your starting eye pressure, glaucoma type, and how the bleb heals over time.
Needling is a minor office-based procedure where a small needle is used to release scar tissue that may form around the filtering bleb. Studies report needling rates ranging from roughly 30 to 45 percent within the first one to two years after XEN implantation. Needling is typically performed with a small amount of anti-scarring medication and is a routine part of managing bleb-forming procedures. It does not mean the surgery has failed.
Trabeculectomy generally achieves lower final eye pressures than the XEN and remains the preferred option when very aggressive pressure reduction is needed. However, the XEN offers a better safety profile, a shorter operative time, and fewer complications such as flat anterior chambers or bleb leaks. For many patients with moderate-to-advanced glaucoma, the XEN provides a strong balance between effectiveness and safety.
As with any surgical procedure, the XEN Gel Stent carries some risks. Potential complications include temporary low eye pressure (hypotony), bleb-related issues, stent exposure or migration, and rarely infection. Serious complications are uncommon, and the overall complication rate is lower than that of traditional filtering surgeries. Our team discusses all potential risks with you before the procedure so you can make a fully informed decision.
Yes, the XEN Gel Stent can be implanted at the same time as cataract surgery. Combining both procedures allows patients to address two conditions in a single session, which can reduce overall recovery time and the total number of surgeries needed. Our glaucoma specialists coordinate these combined procedures when appropriate based on your individual needs.
The XEN Gel Stent is FDA-approved and is covered by most major insurance plans, including Medicare, when deemed medically necessary. Coverage can vary depending on your specific plan and diagnosis. Our team can help verify your insurance benefits before scheduling your procedure.
Take the Next Step Toward Better Glaucoma Control
Managing moderate-to-advanced glaucoma requires a treatment plan that matches the severity of your condition and your goals for daily life. The fellowship-trained glaucoma specialists at Greenwich Ophthalmology Associates in the greater NY/CT region are experienced in advanced procedures like the XEN Gel Stent and can help determine whether this option is right for you. We are here to guide you through every step, from initial evaluation to long-term follow-up care. Schedule a consultation to learn how we can help protect your vision for the years ahead.
We encourage you to bring your questions and concerns to your next appointment so we can develop a care plan that addresses your goals and lifestyle.
Learn More About Related Topics
To further your understanding, explore our resources on Pigmentary Glaucoma and Pseudoexfoliation Glaucoma, Angle-Closure Glaucoma: Recognizing the Emergency, and Angle-Closure Glaucoma: Symptoms & Emergency Treatment.
You may also find these pages helpful: Brimonidine Eye Drops for Glaucoma, Caffeine and Glaucoma: How Much Is Too Much?, and Can Glaucoma Be Cured or Reversed?.
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