University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy.
Ophthalmology Clinic, Department of Medicine and Aging Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 66100, Chieti, CH, Italy.
Graefes Arch Clin Exp Ophthalmol. 2020 Aug;258(8):1763-1770. doi: 10.1007/s00417-020-04671-2. Epub 2020 May 15.
To describe and compare the conjunctival filtering bleb features after XEN gel implantation and trabeculectomy using anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM).
Fifty-two patients who underwent completely successful trabeculectomy (24 eyes) or completely successful XEN gel implantation (28 eyes) were consecutively enrolled. At the sixth-month follow-up, filtering blebs were analyzed with AS-OCT and IVCM. The main outcomes were the following: (i) bleb-wall epithelium cyst-like structure density and area (BECSD, BSCSA), (ii) bleb-wall sub-epithelium cyst-like structure density and area (BSCSD, BSCSA,), (iii) bleb-wall thickness (BT), (iv) bleb-wall epithelial thickness (BET), (v) bleb-wall reflectivity (BR), and (vi) bleb height (BH), for AS-OCT. Mean microcyst density (MMD) and area (MMA) and stromal meshwork reflectivity (SMR) were the IVCM outcomes.
Six-month intraocular pressure was 11.46 ± 3.09 and 10.06 ± 3.39 mmHg in the XEN gel implantation and trabeculectomy, respectively (p > 0.05). At AS-OCT, XEN gel blebs showed lower BH, BT, BET, BR, (p < 0.001), and BECSA values (p < 0.005), and a higher BECSD (p < 0.05) compared with trabeculectomy blebs. At IVCM, MMA and SMR values were lower in the XEN gel implantation, compared with trabeculectomy (p < 0.05). BECSD and BSCSD negatively correlated with BR (p < 0.01; r = - 0.110; p < 0.01; r = - 0.249), whereas BR strongly correlated with SMR (p < 0.001; r = 0.819).
Successful filtering blebs after XEN gel implantation appeared flatter and thinner, with a higher number of epithelial cysts and a hypo-reflective bleb wall compared with trabeculectomy. These aspects may depend on the different intra-operative tissue manipulation and/or on different aqueous humor dynamics in the sub-conjunctiva between surgeries.
使用眼前节光学相干断层扫描（AS-OCT）和活体共聚焦显微镜（IVCM）描述和比较 XEN 凝胶植入和小梁切除术治疗后的滤过泡特征。
连续纳入 52 例完全成功的小梁切除术（24 只眼）或完全成功的 XEN 凝胶植入术（28 只眼）患者。在第六个月随访时，使用 AS-OCT 和 IVCM 分析滤过泡。主要结果如下：（i）滤过泡壁上皮细胞囊泡样结构密度和面积（BECSD、BSCSA），（ii）滤过泡壁下上皮细胞囊泡样结构密度和面积（BSCSD、BSCSA），（iii）滤过泡壁厚度（BT），（iv）滤过泡壁上皮厚度（BET），（v）滤过泡壁反射率（BR）和（vi）滤过泡高度（BH），用于 AS-OCT。平均微囊密度（MMD）和面积（MMA）和基质网格反射率（SMR）为 IVCM 结果。
XEN 凝胶植入组和小梁切除术组的 6 个月眼内压分别为 11.46±3.09mmHg 和 10.06±3.39mmHg（p>0.05）。在 AS-OCT 中，XEN 凝胶滤过泡的 BH、BT、BET、BR 较低（p<0.001），BECSA 值较低（p<0.005），而 BECSD 较高（p<0.05）。与小梁切除术相比，XEN 凝胶植入组 IVCM 中的 MMA 和 SMR 值较低（p<0.05）。BECSD 和 BSCSD 与 BR 呈负相关（p<0.01；r=-0.110；p<0.01；r=-0.249），而 BR 与 SMR 呈强相关（p<0.001；r=0.819）。
与小梁切除术相比，XEN 凝胶植入术后的滤过泡外观更平坦、更薄，上皮囊泡数量更多，滤过泡壁低反射。这些方面可能取决于手术中不同的组织操作和/或手术中结膜下房水动力学的不同。
