XEN® at Work

Eye stent relieves high pressure of glaucoma.

As an engineer with the Merchant Marine, Sean Grace bears responsibility for the operation of a self-contained city at sea. The merchant vessels transport goods and materials throughout the world and require an array of personnel to sail efficiently.

Sean Grace

“We have three departments: the deck department that navigates the vessel, the steward department that feeds the crew and the engineering department that provides the propulsion,” Sean relates. “Engineering also repairs any equipment and maintains the generators, which produce our electricity, and the evaporators, which make our water.

“In addition, we do extensive training and drilling in anticipation of an emergency, such as a fire, because we can’t call the fire department in the middle of the Pacific or Atlantic. My job is like the movie Groundhog Day. It’s the same thing repeating over and over, but it’s a very intensive job in a very isolated environment.”

Sean, 54, started his career as a wiper, an entry-level position, making him a junior member of the engineering crew. Over time, he worked his way up to second engineer. With the advancement, Sean became a licensed officer and joined a trade union, the Marine Engineers’ Beneficial Association, which requires a yearly physical. During one of those exams, Sean learned he had glaucoma, an eye disease associated with high pressure in the eye.

“I had no symptoms that I was aware of,” Sean says. “Occasionally, I got a sharp pain in my eye, but then it would go away and not happen again for six months or a year. In retrospect, I realize that was a sign, but there were no overt or glaringly obvious signs that I was suffering with glaucoma.”

Initially, Sean visited a specialist in his native New York who prescribed two eye drop medications to reduce the pressure. Later, he moved to Florida and bought a home in Brandon, so he began seeing the eye specialists at Brandon Eye Associates. When the high pressure persisted, doctors added a third medication.

“I normally work for three or four months at a time, sometimes longer,” Sean states. “I’d get a 90-day supply of medication and then go to work, and sometimes I’d run out. There were other times when, due to the nature of my job, I wasn’t able to take my drops as regularly scheduled, so my pressures remained high.

“Not long ago, we were sailing in Asia, and I wasn’t home in Brandon for about a year. When I got back, my pressures were up again. And I actually lost some field of vision on the periphery, so my doctor at Brandon Eye Associates, Dr. Jennifer Landy, suggested that I see Dr. Ilyas and get a certain procedure.”

Haroon Ilyas, MD, is a board-certified, fellowship-trained eye surgeon at Brandon Eye Associates. He measured Sean’s eye pressure and evaluated his compliance with treatment.

The doctor recommended using the XEN® gel stent, which is implanted during a minimally invasive glaucoma surgery (MIGS), to reduce Sean’s eye pressure when medications aren’t controlling the disease.

Normal pressure is typically around 21 millimeters or less, the doctor explains. Sean’s pressures were in the 30s.

“Because his glaucoma was progressing, we elected to use the XEN stent, which is a surgical implant designed to lower high eye pressure in open-angle glaucoma when medication treatment is not controlling the disease,” Dr. Ilyas says.

“The XEN stent is an exciting option to decrease medication burden and cost for patients, and it eliminates compliance problems.”

Eyelash-Sized Conduit

Open-angle is the most common type of glaucoma. It occurs when the drainage angle formed by the cornea and iris remains open but the specialized tissue responsible for draining the fluid of the eye, the trabecular meshwork, is partially blocked. As a result, fluid builds up and pressure increases. Elevated eye pressure eventually damages the optic nerve and retinal ganglion cells, causing vision loss.

“The trouble with open-angle glaucoma is that the early signs are typically never noticed by patients,” Dr. Ilyas notes. “It is a slow, progressive disease that causes vision loss, and the only way we know of definitively controlling it is to lower the eye pressure.”

In Sean’s case, that wasn’t happening with medication, so Dr. Ilyas opted for the XEN gel stent. The eye surgeon performed the procedure on Sean’s left eye in early November.

“My left eye is done and my pressure is excellent. And it’s being maintained without any of the maintenance medications or drops.” – Sean

“The XEN gel stent is a small tube, about the length of an eyelash,” Dr. Ilyas describes. “When this tube is surgically inserted into the eye, it becomes soft and flexible. It draws fluid from inside the eye to outside the eye, which helps lower eye pressure.

“The XEN stent is made of porcine gelatin cross-linked with glutaraldehyde, an organic compound. It is placed under the conjunctiva, the clear membrane that covers the white of the eye, and is designed to remain in the eye permanently.”

MIGS to insert the XEN gel stent can be performed as a standalone operation or during cataract surgery. Sean’s surgery was a standalone procedure.

“I was awake for the surgery, but they numbed my eye,” Sean recalls. “Dr. Ilyas said, Let me know if you feel anything. At one point, I did feel a little something, so I let him know, and he numbed my eye a little more. I’ve been recovering for about a month now, and I’m only using a steroid drop in my left eye.”

“The goal with Sean was to lower his eye pressure surgically so he can stop using the eye drops and won’t have to worry about forgetting them when he gets busy at work,” Dr. Ilyas discloses. “We were successful in doing that in his left eye, and he plans to have surgery on his right eye.”

Sean enjoys playing guitar when he’s not working with the Merchant Marine.

Excellent Recovery

For Sean, surgery and the XEN gel stent succeeded in reducing the elevated pressure related to glaucoma. As a result, he’s been able to discontinue the medications in the operative eye.

“My left eye is done and my pressure is excellent,” Sean raves. “And it’s being maintained without any of the maintenance medications or drops. The pressure in my right eye remains high, with medication.”

The recovery process includes massaging the operative eye three to four times a day. Dr. Ilyas explained to Sean how this helps.

“As I understand it, the eye has fluid going through it continuously day and night, and the massaging helps to push fluid out and keep the pressure down,” Sean says. “Dr. Ilyas said I only have to do the massaging for a couple of months and then my eye will regulate itself.

“I highly recommend this procedure to anyone with glaucoma, and I highly recommend Dr. Ilyas and Brandon Eye Associates. I have nothing but the highest praise for them. They take great care of me!”

FHCN article by Patti DiPanfilo. Photo by Jordan Pysz. Xen graphics courtesy of www.xengelstent.com. mkb
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    • Brandon Eye Associates, PA

      The doctors at Brandon Eye Associates use their hearts to help care for your eyes. In addition to being lauded, board-certified physicians at the height of their careers, your Brandon, Sun City Center and Plant City Ophthalmologists are car... Read More

    • Haroon Ilyas, MD

      Haroon Ilyas, MD, is board certified by the American Board of Ophthalmology. Dr. Ilyas completed his undergraduate studies at Duquesne University in Pittsburgh, PA, earning a bachelor’s degree in molecular biology. He attended medical school at... Read More