Department of Ophthalmology and Optometry, University Clinic Salzburg, Paracelsus Medical University, Salzburg, Austria.
Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria.
Acta Ophthalmol. 2019 Mar;97(2):e231-e237. doi: 10.1111/aos.13902. Epub 2018 Aug 29.
Like the classic trabeculectomy, the minimally invasive, ab interno XEN Glaucoma Gel Microstent (XEN-GGM) creates a filtration bleb in the conjunctiva. The goal of this study was to investigate internal bleb morphology over time with anterior segment optical coherence tomography (AS-OCT) after XEN-GGM implantation.
In a prospective, single-centre, single-armed cohort study, blebs were characterized using AS-OCT in 78 eyes of 60 patients at day 1, at weeks 1 and 2 and at months 1, 3, 6, 9 and 12 after XEN-GGM implantation in patients with open-angle glaucoma. Morphological bleb characteristics were correlated with IOP and surgical success.
Anterior segment optical coherence tomography data indicate early and late bleb changes in the course of 12 months. Uniform blebs in AS-OCTs showed higher IOPs at all examinations between week 1 (17.7 ± 4.8 mmHg versus 11.3 ± 7.1 mmHg, p = 0.001) and month 3 (16.4 ± 6.1 versus 13.4 ± 6.1, p = 0.04). Subconjunctival tissue separation bleb morphology was associated with lower mean IOPs during the course of 12 months (r = -0.75, p = 0.031). Predictors for surgical failure at month 12 were microcystic multiform bleb morphology in AS-OCT at month 3 (60% versus 15%, relative risk 4.0, p = 0.043) and uniform bleb morphology at month 9 (33% versus 23%, relative risk 1.4, p = 0.015).
Bleb appearance after XEN surgery seems to be different to classic trabeculectomy literature. The present data suggest correlation of IOP and surgical long-term success with bleb morphology in AS-OCT. Prevalence of small diffuse cysts is directly associated with lower IOPs, while cystic encapsulation at 3 months predicts higher surgical failure.
与经典小梁切除术一样，微创、内路 XEN 青光眼凝胶微支架（XEN-GGM）在结膜下形成滤过泡。本研究的目的是使用眼前节光学相干断层扫描（AS-OCT）在 XEN-GGM 植入后随时间观察内滤过泡的形态。
在一项前瞻性、单中心、单臂队列研究中，在接受开角型青光眼治疗的 60 例 78 只眼中，在 XEN-GGM 植入后第 1、1、2 周、第 1、3、6、9 和 12 个月，使用 AS-OCT 对滤过泡进行特征描述。将形态滤过泡特征与 IOP 和手术成功率相关联。
AS-OCT 数据表明，在 12 个月的过程中，早期和晚期滤过泡发生变化。在所有检查中，AS-OCT 中均匀的滤过泡在第 1 周（17.7±4.8mmHg 比 11.3±7.1mmHg，p=0.001）和第 3 个月（16.4±6.1mmHg 比 13.4±6.1mmHg，p=0.04）的 IOP 更高。在 12 个月的过程中，结膜下组织分离的滤过泡形态与较低的平均 IOP 相关（r=-0.75，p=0.031）。第 12 个月手术失败的预测因素为第 3 个月 AS-OCT 中小囊多形性滤过泡形态（60%比 15%，相对风险 4.0，p=0.043）和第 9 个月均匀滤过泡形态（33%比 23%，相对风险 1.4，p=0.015）。
XEN 手术后的滤过泡外观似乎与经典小梁切除术文献不同。本研究数据表明，AS-OCT 中的滤过泡形态与 IOP 和手术长期成功率相关。小弥漫性囊肿的患病率与较低的 IOP 直接相关，而 3 个月时的囊性包裹则预示着较高的手术失败风险。
