In this case, an 87-year-old White female presented 6 weeks after implantation of Xen gel stent (Allergan) with an encapsulated nasal bleb extending inferiorly. The Xen implant was visible subconjunctivally, with the distal end visible within the bleb.
After placing a traction suture, a 27-gauge needle was used subconjunctivally to puncture the encapsulated bleb. A Grover-Fellman microshunt spatula (Epsilon Instruments) was then used to needle the bleb, extending it to a more superotemporal position. An 8-0 Vycril (Ethicron) interrupted suture was then used to close the needle point.
Two figure-eight 10-0 nylon bleb compression sutures were placed nasally to prevent persistent extension of the bleb to the inferior nasal quadrants. To prevent conjunctival scarring, 20 μg of mitomycin C were given superiorly and spread temporally. At the conclusion of the case, an antibiotic and steroid were injected in the inferior cul de sac.
Over the postoperative period, there was no reformation of the nasal bleb. A superior, more temporal bleb was observed with maintenance of Xen function and intraocular pressure.
