Loscos-Arenas Jordi, Parera-Arranz Angels, Romera-Romera Pau, Castellvi-Manent Jordi, Sabala-Llopart Antoni, de la Cámara-Hermoso Julio
Department of Ophthalmology, Hospital Universitari Germans Trias i Pujol, Servicio de Oftalmología, Universitat Autonoma Barcelona, Badalona, Barcelona, Spain.
J Glaucoma. 2015 Aug;24(6):421-5. doi: 10.1097/IJG.0000000000000253.
To report the safety and the effectiveness of deep sclerectomy (DS) with a new nonabsorbable uveoscleral hema implant (Esnoper-Clip) designed to increase trabecular and uveoscleral outflow and to achieve higher intrascleral blebs.
Twenty-seven eyes of 27 patients with open-angle glaucoma, who underwent DS with an Esnoper-Clip implant, were included in this study. All patients were followed up after 12 months.
A significant decrease in intraocular pressure was observed after surgery, changing from a preoperative mean of 26.6±5.2 mm Hg to a postoperative mean of 15.3±5 mm Hg (P<0.001) at 12 months. There was also a significant reduction in the number of glaucoma drugs needed, varying from 2.5 per patient to 0.3 (P<0.001) 1 year after surgery. The main intrascleral lake height and volume at 12 months was 0.7±0.1 mm and 3.9±1.3 mm, respectively. No intraoperative complications occurred. The main postoperative complications were a positive Seidel test result at 24 hours in 2 eyes (7.4%), hyphema in 2 eyes (7.4%), and choroidal detachment in 1 eye (3.7%). All these complications resolved successfully. The need for additional mitomycin-C injections was recorded in 4 eyes (14.8%), twice in 2 of them. Twelve eyes (44.4%) underwent postsurgical Nd:YAG laser goniopuncture with a mean time between surgery and this procedure of 4.3 months. Mean intraocular pressure after Nd:YAG laser goniopuncture decreased from 19.2 to 15.5 mm Hg (P<0.001).
DS with an uveoscleral hema implant (Esnoper-Clip) is a safe and effective technique for the management of open-angle glaucoma.
报告采用一种新型不可吸收性葡萄膜巩膜血液植入物（Esnoper-Clip）的深层巩膜切除术（DS）的安全性和有效性，该植入物旨在增加小梁网和葡萄膜巩膜流出量，并形成更高的巩膜内泡。
本研究纳入了27例接受了带Esnoper-Clip植入物的DS手术的开角型青光眼患者的27只眼。所有患者均随访12个月。
术后观察到眼压显著降低，12个月时从术前平均26.6±5.2 mmHg降至术后平均15.3±5 mmHg（P<0.001）。术后所需青光眼药物数量也显著减少，术后1年时从每位患者平均2.5种降至0.3种（P<0.001）。12个月时主要巩膜内湖高度和体积分别为0.7±0.1 mm和3.9±1.3 mm。术中无并发症发生。主要术后并发症为2只眼（7.4%）在24小时时Seidel试验结果为阳性，2只眼（7.4%）发生前房积血，1只眼（3.7%）发生脉络膜脱离。所有这些并发症均成功解决。4只眼（14.8%）记录有额外丝裂霉素C注射需求，其中2只眼注射了两次。12只眼（44.4%）术后接受了Nd:YAG激光房角穿刺，手术与该操作之间的平均时间为4.3个月。Nd:YAG激光房角穿刺术后平均眼压从19.2 mmHg降至15.5 mmHg（P<0.001）。
采用葡萄膜巩膜血液植入物（Esnoper-Clip）的深层巩膜切除术是一种治疗开角型青光眼的安全有效的技术。
