Yu Jonathan Thur Sian, Au Leon
Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
Eur J Ophthalmol. 2020 Jan;30(1):217-220. doi: 10.1177/1120672119836339. Epub 2019 Mar 12.
Over-filtration and subsequent hypotony are recognised complications of penetrating glaucoma procedures, especially when augmented with antimetabolites. Patients with uveitis are especially at risk of hypotony and this can reduce the final acuity achieved, compromise surgical outcomes and adversely affect the inflammatory status. The incidence of hypotony following XEN45 implant insertion is higher for uveitic patients and we present a method of surgically addressing this hypotony with transconjunctival compression sutures that are placed over the overdraining XEN45 implant.
We present a retrospective case series of consecutive uveitic glaucoma patients who had conjunctival compression sutures between 2015 and 2018 following XEN45 insertion, at the Manchester Royal Eye Hospital, UK. Two 9/0 nylon sutures were placed in a horizontal figure-of-eight conformation transconjunctivally across the overdraining bleb: one directly over the XEN45 implant and one at the posterior limit of the implant in order to restrict flow.
Three patients underwent conjunctival compression sutures following XEN45 implant-related hypotony and all three had successful resolution of their hypotony and visual symptoms. No patients required long-term topical agents to control their intraocular pressure.
Conjunctival compression sutures are an effective option for addressing persistent hypotony following XEN45 implant insertion in patients with uveitic glaucoma.
过度滤过及随后的低眼压是穿透性青光眼手术公认的并发症，尤其是在使用抗代谢药物辅助治疗时。葡萄膜炎患者尤其有发生低眼压的风险，这会降低最终获得的视力，影响手术效果，并对炎症状态产生不利影响。对于葡萄膜炎患者，XEN45植入术后低眼压的发生率更高，我们介绍一种通过在过度引流的XEN45植入物上方放置经结膜压迫缝线来手术解决这种低眼压的方法。
我们回顾性分析了2015年至2018年在英国曼彻斯特皇家眼科医院接受XEN45植入术后行结膜压迫缝线术的连续性葡萄膜炎性青光眼患者病例系列。两根9/0尼龙缝线经结膜以水平8字形穿过过度引流的泡：一根直接位于XEN45植入物上方，另一根位于植入物后缘以限制房水流动。
3例患者在XEN45植入相关低眼压后接受了结膜压迫缝线术，所有3例患者的低眼压及视觉症状均成功缓解。无一例患者需要长期使用局部药物来控制眼压。
结膜压迫缝线术是解决葡萄膜炎性青光眼患者XEN45植入术后持续性低眼压的有效选择。
