Recurrent delayed hyphema following latanoprost/netarsudil initiation in an eye with a XEN 63 gel stent: a case report.
- 1Institute of Ophthalmology, Santa Croce e Carle Hospital, Cuneo, Italy.
- 2Eye Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
Abstract
Purpose
To describe recurrent delayed hyphema following initiation of fixed-dose latanoprost/netarsudil in an eye with a previous XEN 63 gel stent, and to discuss whether the associated IOP reduction may have unmasked a pre-existing peri-implant reflux pathway.Observations
A 72-year-old woman with advanced primary open-angle glaucoma and previous ab interno XEN 63 gel stent implantation developed recurrent spontaneous hyphema shortly after bimatoprost/timolol was replaced with latanoprost/netarsudil. Intraocular pressure decreased from 17-19 mmHg to 8-9 mmHg after treatment initiation. The first episode occurred nine days later, with blurred vision, a small anterior chamber hyphema, and fine endothelial blood deposits. Gonioscopy showed active blood reflux from tissue surrounding the proximal intracameral XEN segment, without bleeding from other angle structures. Recurrent episodes occurred despite conservative management and, subsequently, despite discontinuation of latanoprost/netarsudil. Because the peri-implant region was repeatedly identified as the reflux site, the XEN stent was eventually removed. No further bleeding episodes were observed after explantation.Conclusions and importance
The clinical course is consistent with a susceptible peri-implant anatomical configuration contributing to recurrent blood reflux. The temporal association between latanoprost/netarsudil initiation, marked IOP reduction, and the first hyphema suggests a possible precipitating or unmasking role, but does not establish drug causality. Delayed or recurrent hyphema after XEN implantation should prompt review of recent medication changes and careful gonioscopic inspection of the proximal XEN segment.
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BibTeX
@article{greco2026recurrent,
title = {{Recurrent delayed hyphema following latanoprost/netarsudil initiation in an eye with a XEN 63 gel stent: a case report.}},
author = {Antonio Greco and Valerio Calabresi and Maria Marenco and Fabio Garavelli and Giuseppe Giannaccare and Agostino Salvatore Vaiano},
journal = {American journal of ophthalmology case reports},
year = {2026},
month = oct,
doi = {10.1016/j.ajoc.2026.102680},
url = {https://europepmc.org/article/MED/42927338},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Recurrent delayed hyphema following latanoprost/netarsudil initiation in an eye with a XEN 63 gel stent: a case report.
AU - Antonio Greco
AU - Valerio Calabresi
AU - Maria Marenco
AU - Fabio Garavelli
AU - Giuseppe Giannaccare
AU - Agostino Salvatore Vaiano
PY - 2026
DA - 2026/10/15
JO - American journal of ophthalmology case reports
DO - 10.1016/j.ajoc.2026.102680
UR - https://europepmc.org/article/MED/42927338
AB - Purpose To describe recurrent delayed hyphema following initiation of fixed-dose latanoprost/netarsudil in an eye with a previous XEN 63 gel stent, and to discuss whether the associated IOP reduction may have unmasked a pre-existing peri-implant reflux pathway.Observations A 72-year-old woman with advanced primary open-angle glaucoma and previous ab interno XEN 63 gel stent implantation developed recurrent spontaneous hyphema shortly after bimatoprost/timolol was replaced with latanoprost/netarsudil. Intraocular pressure decreased from 17-19 mmHg to 8-9 mmHg after treatment initiation. The first episode occurred nine days later, with blurred vision, a small anterior chamber hyphema, and fine endothelial blood deposits. Gonioscopy showed active blood reflux from tissue surrounding the proximal intracameral XEN segment, without bleeding from other angle structures. Recurrent episodes occurred despite conservative management and, subsequently, despite discontinuation of latanoprost/netarsudil. Because the peri-implant region was repeatedly identified as the reflux site, the XEN stent was eventually removed. No further bleeding episodes were observed after explantation.Conclusions and importance The clinical course is consistent with a susceptible peri-implant anatomical configuration contributing to recurrent blood reflux. The temporal association between latanoprost/netarsudil initiation, marked IOP reduction, and the first hyphema suggests a possible precipitating or unmasking role, but does not establish drug causality. Delayed or recurrent hyphema after XEN implantation should prompt review of recent medication changes and careful gonioscopic inspection of the proximal XEN segment.
SN - 2451-9936
ER -