Glaucoma Research Centre, Monchoisi Clinic, Swiss Vision Network, Lausanne, Switzerland.
Department of Ophthalmology, University of Colorado School of Medicine, Denver, CO.
J Glaucoma. 2018 Aug;27(8):739-741. doi: 10.1097/IJG.0000000000001002.
In recent years microinvasive glaucoma surgery has risen in popularity. Among microinvasive glaucoma surgery options is the XEN gel stent (Allergan Plc, Dublin, Ireland), a 45 μm wide ab-interno microstent. It has proven effective in lowering intraocular pressure (IOP) with low complication rates. However, XEN gel stents can become obstructed and cause postoperative rise in IOP. The causes and predicting factors for such obstructions still requires further research.
We describe the case of a 69-year-old male patient, with traumatic glaucoma and chronic intraocular inflammation showed by laser flare photometry, following childhood trauma and anterior segment surgery. Uncontrollable IOP despite maximal antiglaucomatous therapy was managed with XEN-augmented Baerveldt surgery. Despite good initial filtration and IOP control, the XEN stent became obstructed and was surgically replaced. After a month, the new stent became obstructed and was replaced by a thicker-lumened Baerveldt tube. This restored good filtration, and adequate IOP was maintained postoperatively. Microscopic examination of the obstructed XEN stent showed a dense fibrin plug.
This case report shows that fibrin formation could be an important factor in XEN gel stent obstruction, even in initially successfully filtering stents. The association of fibrinogenesis and intraocular inflammation could add a note of caution to the use of XEN gel stents in complicated cataract surgery, or advocate for aggressive anti-inflammatory treatments postoperatively. This could lead to a refinement in success predictors and better patient selection for XEN surgery. Finally, this could open the way to new management options for persistent obstructions, including pharmaceutical fibrinolysis.
近年来，微创青光眼手术越来越受欢迎。微创青光眼手术的选择之一是 XEN 凝胶支架（爱尔兰都柏林的 Allergan Plc），这是一种 45μm 宽的内源性微支架。它已被证明在降低眼内压（IOP）方面有效，且并发症发生率低。然而，XEN 凝胶支架可能会堵塞并导致术后 IOP 升高。导致这种阻塞的原因和预测因素仍需要进一步研究。
我们描述了一位 69 岁男性患者的病例，该患者因儿童时期外伤和前段手术导致外伤性青光眼和慢性眼内炎症，通过激光闪烁光度法显示。尽管进行了最大程度的抗青光眼治疗，但仍无法控制眼压，因此采用 XEN 增强型 Baerveldt 手术进行治疗。尽管初始滤过和 IOP 控制良好，但 XEN 支架发生阻塞并进行了手术更换。一个月后，新的支架发生阻塞并被更换为更粗的 Baerveldt 管。这恢复了良好的滤过功能，术后眼压得到维持。对阻塞的 XEN 支架进行显微镜检查显示有致密的纤维蛋白塞。
本病例报告表明，纤维蛋白形成可能是 XEN 凝胶支架阻塞的一个重要因素，即使是最初成功过滤的支架也是如此。纤维蛋白生成与眼内炎症的关联可能会对在复杂白内障手术中使用 XEN 凝胶支架提出警告，或者提倡术后进行积极的抗炎治疗。这可能会导致对 XEN 手术成功预测因素和更好的患者选择进行细化。最后，这可能会为持续阻塞开辟新的管理选择，包括药物溶栓。
