Last updated: October 2, 2026
The XEN Gel Stent is a small implant that creates a new pathway for aqueous fluid to drain from the front of the eye to a filtering area beneath the conjunctiva. Current United States product information indicates it for management of refractory glaucomas, including cases in which previous surgical treatment has failed and open-angle glaucomas that remain uncontrolled despite maximum tolerated medical therapy.
XEN is a bleb-forming glaucoma procedure. It is not the same as a canal-based MIGS implant, and it is not appropriate for every glaucoma type or every eye with prior surgery. Fichte, Endl & Elmer Eyecare may discuss XEN or another treatment after an individualized glaucoma evaluation. Current availability and the treating surgeon should be confirmed during the consultation.
How XEN Works
The surgeon places the soft gelatin stent through a small incision to create a controlled channel between the anterior chamber and the subconjunctival space. Fluid exits through the stent and forms a filtering bleb. The goal is to lower eye pressure and reduce the risk of additional optic-nerve damage. Surgery cannot restore vision already lost to glaucoma and does not guarantee that drops or future procedures will never be needed.
Who May Be Evaluated
Evaluation considers glaucoma type and severity, pressure target, visual-field and optic-nerve change, medication tolerance, prior laser or surgery, conjunctival scarring, angle anatomy, corneal health, and the patient’s ability to attend close postoperative follow-up. The current labeling includes refractory primary open-angle, pseudoexfoliative, and pigmentary glaucoma with open angles that remain unresponsive to maximum tolerated medical therapy.
Contraindications and Limitations
Current product information lists untreated angle-closure glaucoma, certain prior shunts or conjunctival scarring in the target area, active inflammation, active iris neovascularization, anterior chamber intraocular lenses, silicone oil, and vitreous in the anterior chamber among the contraindications. The complete directions for use contain additional warnings and precautions.
Potential Risks and Follow-Up
Possible complications include pressure that is too low or remains too high, bleeding, inflammation, infection, choroidal fluid, wound leak, stent migration or exposure, blockage, scarring, vision changes, and the need for needling, revision, medication, or another glaucoma operation. Frequent early follow-up may be required to evaluate the bleb and pressure.
XEN Compared With Other Procedures
XEN creates a filtering bleb through a small implant. Trabeculectomy also creates a new drainage pathway but uses a different surgical technique. A tube shunt uses a tube and plate. Canal-based MIGS procedures work through the eye’s conventional drainage system and may have a different pressure-lowering range and follow-up profile. The choice depends on the amount of pressure reduction needed and the individual eye.
Compare glaucoma drops, laser, MIGS, XEN, and traditional surgery.
Questions to Ask the Surgeon
- Why is XEN being considered for my type and stage of glaucoma?
- How does it compare with trabeculectomy or a tube shunt for my target pressure?
- What is the likelihood that needling or revision will be required?
- Could I still need pressure-lowering drops?
- How often will I need postoperative visits?
- Which symptoms require an urgent call?
Schedule a Glaucoma Evaluation
Call 1-800-309-2020 or request an appointment.
Product and Patient Education Sources
This page provides general education and summarizes selected labeling concepts. The complete current directions for use and an individual examination control treatment decisions.
