Loscos Jordi, Valldeperas Xavier, Langohr Klaus, Parera Àngels, Romera Pau, Sabala Antoni, de la Cámara Julio
Department of Ophthalmology, Hospital Universitari Germans Trias i Pujol, Universitat Autonoma de Barcelona, Carretera de Canyet s/n, 08916, Badalona, Spain,
Int Ophthalmol. 2015 Oct;35(5):693-9. doi: 10.1007/s10792-015-0037-y. Epub 2015 Jan 30.
The aim was to report the results of deep sclerectomy (DS) with supraciliary hema implant and the influence of the surgical complications on intraocular pressure (IOP). Forty-eight eyes of 41 patients with open angle glaucoma (OAG), who underwent DS with supraciliary hema implant (Esnoper(®) V-2000), were included in this study. A significant IOP reduction was observed, changing from a preoperative mean of 24.6 ± 6.33 mmHg to 16.5 ± 4.4 mmHg (p < 0.001) at 12 months and 16.1 ± 3.4 mmHg (p < 0.001), at 24 months. Similarly, a significant reduction in the number of glaucoma drugs needed was observed, varying from 2.71 to 0.22 (p < 0.001) and 0.4 (p < 0.001), 1 and 2 years after surgery. Goniopuncture with the Nd:Yag Laser was performed in 30 eyes (62.5%) with a mean time between the surgery and the procedure of 150 days, producing a mean IOP reduction of 4.0 mmHg (p < 0.001). The main intraoperative complications were microperforation of the trabeculodescemetic membrane (TDM) in 1 eye (2.08%) The main early postoperative complications were seidel at 24 h in 11 eyes (22.91%), hyphema in 7 eyes (14.58%), choroidal detachment in 3 eyes (6.25%) with macular folds in 2 (4.16%) and need for additional mitomycin injections in 2 eyes (4.16%). All these complications were spontaneously resolved. No correlation between these complications and final IOP was found, but a significant correlation between the presence of hyphema and higher IOP 24 months postoperatively (p = 0.048) was observed. DS with supraciliary hema implant is a safe and effective technique for the management of OAG. The presence of hyphema during the first week after the surgery could be considered as a negative prognostic factor in DS with supraciliary implantation.
目的是报告采用睫状体上腔血植入物的深层巩膜切除术（DS）的结果以及手术并发症对眼压（IOP）的影响。本研究纳入了41例开角型青光眼（OAG）患者的48只眼，这些患者接受了采用睫状体上腔血植入物（Esnoper(®) V - 2000）的DS手术。观察到眼压显著降低，术前平均眼压为24.6±6.33 mmHg，12个月时降至16.5±4.4 mmHg（p < 0.001），24个月时降至16.1±3.4 mmHg（p < 0.001）。同样，观察到所需青光眼药物数量显著减少，术后1年和2年分别从2.71降至0.22（p < 0.001）和0.4（p < 0.001）。30只眼（62.5%）进行了Nd:Yag激光前房角穿刺，手术与该操作之间的平均时间为150天，平均眼压降低4.0 mmHg（p < 0.001）。主要术中并发症为1只眼（2.08%）小梁 - Descemet膜（TDM）微穿孔。主要早期术后并发症为24小时时11只眼（22.91%）出现前房渗漏，7只眼（14.58%）出现前房积血，3只眼（6.25%）出现脉络膜脱离，其中2只眼（4.16%）伴有黄斑皱褶，2只眼（4.16%）需要额外注射丝裂霉素。所有这些并发症均自行缓解。未发现这些并发症与最终眼压之间存在相关性，但观察到前房积血的存在与术后24个月较高眼压之间存在显著相关性（p = 0.048）。采用睫状体上腔血植入物的DS是治疗OAG的一种安全有效的技术。术后第一周出现前房积血可被视为睫状体上腔植入DS手术的一个不良预后因素。
