Holló Gábor, Naghizadeh Farzaneh
Department of Ophthalmology, Semmelweis University, Budapest - Hungary.
Eur J Ophthalmol. 2014 Jul-Aug;24(4):617-9. doi: 10.5301/ejo.5000406. Epub 2013 Dec 5.
To investigate the mechanism of fibrosis-related failure of an Ex-PRESS shunt implanted under the scleral flap in trabeculectomy.
A patient with end-stage secondary open-angle glaucoma on his only functioning right eye was referred for glaucoma valve implantation. His right eye had undergone congenital cataract surgery in early childhood and posterior chamber lens implantation 20 years ago. During the last 18 months, the right eye underwent pars plana vitrectomy with silicone oil implantation, silicone oil removal, 2 sessions of cyclophotocoagulation, 2 failed trabeculectomies (one of them combined with Ex-PRESS shunt implantation under the scleral flap), and 4 trabeculectomy revisions. At presentation, the intraocular pressure varied between 47 and 52 mm Hg on maximal systemic and topical intraocular pressure-lowering medication. Serial limbus parallel scans made with the CAM-L cornea lens adapter of the Optovue Fourier-domain optical coherence tomograph revealed that the space between the inner surface of the scleral flap and the external orifice of the Ex-PRESS shunt was filled by scar tissue, and the scar tissue appeared to invade the lumen of the shunt.
The findings suggest that failure of an Ex-PRESS shunt is not always caused by episcleral fibrosis but may also be caused by scar formation between the scleral flap and the implant, inside the surgical sclera tunnel.
研究小梁切除术中巩膜瓣下植入Ex-PRESS分流管发生纤维化相关失败的机制。
一名患有终末期继发性开角型青光眼且仅右眼有功能的患者被转诊进行青光眼瓣膜植入术。他的右眼在幼儿期接受过先天性白内障手术，并于20年前植入了后房型人工晶状体。在过去的18个月里，右眼接受了玻璃体切除联合硅油植入术、硅油取出术、2次睫状体光凝术、2次小梁切除术失败（其中一次联合巩膜瓣下Ex-PRESS分流管植入）以及4次小梁切除术修复。就诊时，在使用最大剂量全身和局部降眼压药物的情况下，眼压在47至52毫米汞柱之间波动。使用Optovue傅里叶域光学相干断层扫描仪的CAM-L角膜透镜适配器进行的系列角膜缘平行扫描显示，巩膜瓣内表面与Ex-PRESS分流管外口之间的间隙被瘢痕组织填充，且瘢痕组织似乎侵入了分流管腔。
研究结果表明，Ex-PRESS分流管失败并非总是由巩膜表面纤维化引起，也可能是由于手术巩膜隧道内巩膜瓣与植入物之间形成瘢痕所致。
