Refractory glaucoma continues to be a challenge for the glaucoma surgeon. These are eyes that have already undergone surgery or cyclophotodestruction but continue to progress despite maximum pharmacological treatment. Minimally invasive glaucoma surgeries (MIGS) in refractory glaucoma can provide an additional level of safety that these patients require, as they are often multi-treated eyes, and in many cases, with advanced glaucoma. Trabecular MIGS [1] would not achieve sufficiently low target pressures, unlike bleb-forming MIGS (or MIBS: Minimally Invasive Bleb-Forming Surgery), which would be the indicated techniques in these types of eyes [2].

Glaucoma surgery in the lower quadrant is not without risks. They are often more dysesthetic blebs, with a higher risk of perforation and consequently endophthalmitis, but in many cases, they are the only quadrants with viable conjunctiva for surgery.

We present the case of a patient with a single eye, refractory myopic glaucoma with several previous glaucoma surgeries, who underwent implantation of Xen 63® (Abbvie, Illinois, U.S.A) in the inferonasal quadrant with good postoperative pressure control.