Department of Ophthalmology, University Medical Center, Mainz, Germany.
J Glaucoma. 2019 Nov;28(11):1015-1018. doi: 10.1097/IJG.0000000000001356.
Tube implants can lead to long-term decompensation of the cornea after decades, in particular in complicated childhood glaucoma, because of a variety of causes including contact between the tube tip and the corneal endothelium. The augmentation of a XEN implant with a Baerveldt (250) tube implant, introduced 2016 by Mermoud et al for refractory glaucoma in adult patients, may reduce this risk in children. In our retrospective study, we report on the XEN-augmented Baerveldt (250) tube implant in children.
Ten consecutive patients with refractory childhood glaucoma who underwent XEN-augmented Baerveldt implantation by a single surgeon (F.G.) between January 2016 and August 2018 were retrospectively analyzed. In this technique, a XEN tube was inserted under a standard scleral flap from outside into the anterior chamber and its outer end was connected to the Baerveldt (250) tube. The follow-up consisted of regular anterior and posterior segment examination with intraocular pressure (IOP) measurements using a hand-held slit lamp and a Perkins applanation tonometer and/or rebound tonometer (Icare).
Ten cases (6 female individuals, 4 male individuals, median age 6 years) were operated using a XEN-augmented Baerveldt implant [aphakic glaucoma, primary congenital glaucoma, secondary congenital glaucoma (Peters anomaly), ectropion uveae, and Stickler syndrome were 4, 3, 1, 1, and 1]. Before surgery (XEN-augmented Baerveldt implantation), median IOP was 31 mm Hg. At the last postoperative follow-up, the mean IOP was 18.5 mm Hg with a median follow-up period of 13 months (range, 3 to 21 mo). No shallow or flat anterior chamber was observed. In all cases, this technique could be performed without intraoperative complications. In 3 cases, however, a surgical revision was necessary. There was no prolonged postoperative hypotony or short-term corneal alteration. By using an S-shaped loop the original Baerveldt tube length could be preserved for potential future use. In a total of 6 out of 10 cases, the procedure was a complete success (IOP, ≤20 mm Hg without additional medication).
XEN-augmented Baerveldt implantation was used for refractory pediatric glaucoma in which conventional surgery had already failed. A new additional modification using an S-shaped loop was introduced. Short-term IOP control seems promising, but long-term results are still pending and the long-term efficacy and safety must still be proven before this technique can be generally recommended.
管植入物在几十年后会导致角膜长期失代偿，尤其是在复杂的儿童青光眼，这是由于各种原因，包括管尖端与角膜内皮接触。2016 年，Mermoud 等人引入了 Baerveldt（250）管植入物增强 Xen 植入物，用于治疗成年患者的难治性青光眼，这可能会降低儿童的这种风险。在我们的回顾性研究中，我们报告了儿童中使用 Xen 增强型 Baerveldt（250）管植入物的情况。
2016 年 1 月至 2018 年 8 月，一位外科医生（F.G.）对 10 例难治性儿童青光眼患者进行了 Xen 增强型 Baerveldt 植入术，这些患者为连续患者。在该技术中，将 Xen 管从外部插入标准巩膜瓣下方，进入前房，其外端与 Baerveldt（250）管连接。随访包括使用手持裂隙灯和 Perkins 压平眼压计和/或回弹眼压计（Icare）定期进行眼前段和后段检查，并测量眼压（IOP）。
使用 Xen 增强型 Baerveldt 植入物对 10 例（6 名女性，4 名男性，中位年龄 6 岁）进行了手术[无晶状体性青光眼、先天性原发性青光眼、继发性先天性青光眼（Peters 异常）、葡萄膜外翻和 Stickler 综合征分别为 4、3、1、1 和 1]。手术前（Xen 增强型 Baerveldt 植入物），中位眼压为 31mmHg。最后一次术后随访时，平均眼压为 18.5mmHg，中位随访时间为 13 个月（范围为 3 至 21 个月）。未观察到浅前房或扁平前房。在所有病例中，均无需术中并发症即可进行此技术。然而，在 3 例中需要进行手术修正。无术后长时间低眼压或短期角膜改变。通过使用 S 形环，可以保留原始 Baerveldt 管的长度以备将来使用。在总共 10 例中的 6 例中，该手术完全成功（IOP，≤20mmHg，无需额外用药）。
Xen 增强型 Baerveldt 植入物用于难治性儿童青光眼，传统手术已失败。引入了一种新的附加修改方法，使用 S 形环。短期眼压控制似乎很有希望，但长期结果仍有待观察，并且在该技术被广泛推荐之前，还需要证明其长期疗效和安全性。
