XEN63 Gel Stent in Glaucoma: Narrative Review and Expert Perspectives on Patient Selection, Surgical Technique, and Perioperative Management.

The XEN gel stent (AbbVie Inc. North Chicago, IL, USA) is a minimally invasive bleb-forming surgical device designed to lower intraocular pressure (IOP). The 63 μm gel stent has a larger lumen than the 45 μm gel stent, creating lower outflow resistance, which may translate into greater IOP-lowering potential. However, the comparative evidence base remains limited, heterogeneous, and largely retrospective; the magnitude and durability of any advantage over the 45 μm device should be interpreted cautiously. This narrative review summarizes the currently available evidence and expert surgical perspectives on patient selection, pre- and intraoperative practices, implantation technique, and postoperative practices with the 63 μm gel implant. Particular attention is given to conjunctival and Tenon's tissue management, use of mitomycin C (MMC), management of postoperative IOP elevation, and recognition and treatment of hypotony. The article is based on a targeted review of the literature combined with unstructured expert input and was not conducted as a systematic review or formal Delphi consensus. Based on the available evidence and expert perspectives, the 63 μm gel stent may be a useful option for selected patients requiring IOP in the low- to mid-teens. However, outcomes depend heavily on patient factors, surgical technique, and postoperative care.