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Background: Patients with juvenile onset ocular hypertension (OHT) have high intraocular pressure (IOP) and may develop early glaucomatous disc damage.
Case presentation: A 26-year-old woman with family history of glaucoma was diagnosed with OHT at age 18. Her vision was 6/6, with a bilateral cup-to-disc ratio of 0.5, normal visual field (VF), and IOP in the mid-teens on 2 topical antiglaucoma medications. The patient started having IOP spikes (20–48 mmHg) in her left eye despite maximum tolerable medical therapy, associated with intermittent headache and nasal step defect on VF test. XEN Gel Stent was implanted and IOP reduced to 10–14 mmHg without medical therapy. Optical coherence tomography angiography showed improvement in optic nerve head (ONH) perfusion density and flux, while the VF defect disappeared.
Conclusion: Improvement in ONH perfusion and reversibility of early glaucomatous VF defect is feasible with prompt XEN Gel Stent implant in juvenile OHT.