Widder Randolf Alexander, Rennings Corinna, Rössler Gernot F
Abteilung für Augenheilkunde, St. Martinus-Krankenhaus Düsseldorf, Gladbacher Str. 26, 40219, Düsseldorf, Deutschland.
Zentrum für Augenheilkunde, Universität zu Köln, Köln, Deutschland.
Ophthalmologe. 2020 Aug;117(8):806-810. doi: 10.1007/s00347-020-01127-0.
After implantation of a XEN gel stent scarring of the conjunctiva with elevation of the intraocular pressure (IOP) is a frequent occurrence. This article describes a surgical revision technique with opening of the conjunctiva and removal of scar tissue. In order to standardize the technique the surgical procedure was divided into nine steps. These steps are shown in the video and a series of images.
Surgery is divided into nine steps: 1) corneal traction suture and topical application of suprarenin, 2) opening of the conjunctiva along the limbus, 3) preparation posteriorly towards the fornix, 4) separation of the stent from the surrounding scar tissue, 5) precise preparation of the stent, 6) removal of additional scar tissue not adhering to the stent, 7) functional testing of the stent, 8) mitomycin C application, 9) closing of the conjunctiva with two corner sutures on the limbus.
After surgery a diffuse filtering bleb is formed. In the literature increased success rates up to 90% (criterion: no further surgery necessary) after open conjunctival revision have been described. Severe side effects are not to be expected and are comparable to those of primary surgery.
Open revision of the conjunctiva after XEN gel stent implantation leads to an effective and enduring lowering of IOP. Revision surgery can be carried out even after a long time period and can keep the patient free of antiglaucomatous drops. Experience in surgery of filtering blebs is advantageous when performing open revision of the conjunctiva.
植入XEN凝胶支架后，结膜瘢痕形成并伴有眼压（IOP）升高是常见现象。本文描述了一种打开结膜并切除瘢痕组织的手术修正技术。为使该技术标准化，将手术过程分为九个步骤。这些步骤在视频和一系列图像中展示。
手术分为九个步骤：1）角膜牵引缝线及局部应用肾上腺素；2）沿角膜缘打开结膜；3）向后穹窿方向进行准备；4）将支架与周围瘢痕组织分离；5）精确处理支架；6）切除未附着于支架的额外瘢痕组织；7）对支架进行功能测试；8）应用丝裂霉素C；9）在角膜缘用两针角部缝线关闭结膜。
手术后形成弥漫性滤过泡。文献报道结膜开放修正术后成功率提高至90%（标准：无需进一步手术）。预计不会出现严重副作用，且与初次手术的副作用相当。
XEN凝胶支架植入后进行结膜开放修正可有效持久地降低眼压。即使在很长一段时间后也可进行修正手术，且能使患者无需使用抗青光眼滴眼液。进行结膜开放修正时，有滤过泡手术经验会更有利。
