Linton Emma, Au Leon
Manchester Royal Eye Hospital, Manchester, UK.
Medical Academic Health Science Centre, University of Manchester, Manchester, UK.
Ophthalmol Ther. 2020 Mar;9(1):149-157. doi: 10.1007/s40123-020-00234-0. Epub 2020 Feb 15.
The Xen® Gel Stent (Allergan, Irvine, CA, USA) is a minimally invasive glaucoma surgery device implanted to reduce intra-ocular pressure (IOP) in glaucoma. The stents can fail to drain post-operatively due to scarring of the conjunctiva around the stent opening. Data on the success rates of revision surgery in patients with Xen stent failure are scarce. We present the first detailed report of the steps, outcomes and complications of Xen revision surgery with 12 months of follow-up data.
We share our experiences on the circumstances in which to perform Xen revision surgery, the steps of the surgery and the results of a retrospective interventional case series of all Xen revisions performed at a single centre from 2013 to 2018.
A total of 151 Xen implants were inserted into eyes at our tertiary centre during the study period, of which 21 eyes (patients) underwent revision surgery. Mean pre-operative IOP was 26.1 (standard deviation 8.3) mmHg with the patient on two drops of anti-glaucoma medication. Four patients were excluded from the analysis due to incomplete data (medical records were unavailable for 2 patients; 1 patient died shortly after surgery; and 1 patient moved to another area). A non-functioning Xen implant was identified in another patient during revision surgery, and the procedure was converted to a trabeculectomy. The remaining 16 patients were included in the analysis, all of whom had a minimum follow-up of 12 months, with the longest follow-up being 4 years following revision surgery. Of these 16 patients, four required needling and 5-fluorouracil injection in the first 12 months following revision surgery, three required further glaucoma drainage surgery due to the failure of the revision surgery to control IOP in the first year and one suffered bleb-related endophthalmitis at the site of previous trabeculectomy surgery. Mean IOP at 12 months following revision surgery was 16.3 (standard deviation 3.7) mmHg on 0.7 drops of anti-glaucoma medication, which equates to a 37.5% reduction in IOP and a 65% reduction in the amount of IOP-lowering drops required.
Our study shares experience on when to perform Xen revision surgery and the steps required. The results of our small cohort are the first in the literature and show that revisions can achieve promising IOP and medication reductions. Some patients still require needling in the post-operative period to optimise outcomes.
Xen®凝胶支架（美国加利福尼亚州尔湾市爱力根公司）是一种用于降低青光眼患者眼压的微创青光眼手术器械。由于支架开口周围结膜瘢痕形成，术后支架可能无法引流。关于Xen支架失败患者翻修手术成功率的数据很少。我们首次详细报告了Xen翻修手术的步骤、结果和并发症，并提供了12个月的随访数据。
我们分享了在何种情况下进行Xen翻修手术的经验、手术步骤以及对2013年至2018年在单一中心进行的所有Xen翻修手术的回顾性介入病例系列的结果。
在研究期间，我们的三级中心共对151只眼睛植入了Xen支架，其中21只眼睛（患者）接受了翻修手术。患者术前平均眼压为26.1（标准差8.3）mmHg，使用两种抗青光眼药物滴眼液。4例患者因数据不完整被排除在分析之外（2例患者病历缺失；1例患者术后不久死亡；1例患者搬到了另一个地区）。在翻修手术中，另一名患者的Xen植入物被确定为无功能，手术改为小梁切除术。其余16例患者被纳入分析，所有患者至少随访12个月，翻修手术后最长随访4年。在这16例患者中，4例在翻修手术后的前12个月需要进行针刺和5-氟尿嘧啶注射，3例因翻修手术在第一年未能控制眼压而需要进一步的青光眼引流手术，1例在先前小梁切除术部位发生了与滤过泡相关的眼内炎。翻修手术后12个月的平均眼压为16.3（标准差3.7）mmHg，使用0.7种抗青光眼药物滴眼液，这相当于眼压降低了37.5%，所需降低眼压的滴眼液用量减少了65%。
我们的研究分享了何时进行Xen翻修手术以及所需步骤的经验。我们小队列研究的结果是文献中的首例，表明翻修手术可以显著降低眼压并减少药物用量。一些患者在术后仍需要针刺以优化手术效果。
