LAUSR

2 days later, when acute endophthalmitis was diagnosed. No protrusion, bleb leakage, or conjunctival erosion was noted. Although pars plana vitrectomy and intravitreal injection of ceftazidime 2.2mg/ 0.1mL and vancomycin 1mg/0.1mL were performed, the vision remained light perception in the end. The culture result of the aqueous aspiration was negative. About 10 cases of Xen gel implant–related endophthalmitis have been reported, including the case in this study.1–7 Protrusion or bleb leakage was noted in 6 of these 10 cases,3–7 and conjunctival erosion was noted in 2 other cases.2,7 As this is a serious adverse event, the author should fully describe the condition of the conjunctiva and bleb on the spot. Apart from the cause of endophthalmitis, timing is another interesting issue. The Xen-related endophthalmitis reported above and ours occurred >3 months after the operation when the wound healing process was deemed complete. Xen45 gel implant, although “microinvasive,” still leads to an immunocompromised status, either due to the use of mitomycin C or due to a tunnel to the intraocular space. Hence, it might be important to remind patients of their immunocompromised status after the filtering surgery, even with Xen gel implant.