Helsinki University Hospital, Helsinki, Finland.
J Glaucoma. 2020 Nov;29(11):1050-1055. doi: 10.1097/IJG.0000000000001608.
PRéCIS:: Retrospective analysis of 38 suprachoroidal glaucoma stent implantations showed sudden intraocular pressure (IOP) elevations to >30 mm Hg in 37% of eyes, 39% needing additional glaucoma surgery, and a success rate at 12 months of 24%.
To study the efficacy and safety of suprachoroidal stent in everyday clinical practice at a tertiary glaucoma center.
This retrospective single-center consecutive case series involved patients treated at Helsinki University Hospital with the CyPass Micro-Stent. Preoperative IOP was ≥18 mm Hg. Success was IOP between 6 and 18 mm Hg and lowering of IOP at least 20% from baseline without an increase in glaucoma medications over baseline or use of oral acetazolamide, and no subsequent glaucoma surgery.
Of the total 38 eyes of 33 patients, 17 had primary open-angle glaucoma, 16 had exfoliative glaucoma, 2 each had uveitic glaucoma or steroid-induced glaucoma, and 1 had pigmentary glaucoma. Median preoperative IOP was 25.8 [interquartile range (IQR), 9.7] mm Hg with a median of 3 (IQR, 2) glaucoma medications. Kaplan-Meier estimate of median survival time was 79 days (95% confidence interval, 37-121 d). Success rate at 12-month follow-up was 24%. Sudden IOP elevation to over 30 mm Hg occurred in 14 eyes (37%). Highest IOP was 68 mm Hg. IOP peaks occurred between 1 week and 8 months after the surgery. In total, 43% of those with IOP elevation to >30 mm Hg had no symptoms. After the CyPass implantation, 15 eyes (39%) needed additional glaucoma surgery within a median of 167 (IQR, 109) days.
Suprachoroidal stenting in a heterogenous clinical population resulted in a high incidence of sudden IOP peaks with a low success rate.
研究在三级青光眼中心的日常临床实践中，巩膜下支架的疗效和安全性。
这是一项回顾性的单中心连续病例系列研究，纳入了在赫尔辛基大学医院接受 CyPass 微支架治疗的患者。术前眼压（IOP）≥18mmHg。成功标准为 IOP 在 6 至 18mmHg 之间，且与基线相比，IOP 降低至少 20%，而无需增加基线以上的青光眼药物或使用口服乙酰唑胺，且无后续青光眼手术。
在 33 例患者的 38 只眼中，17 只为原发性开角型青光眼，16 只为剥脱性青光眼，2 只为葡萄膜炎性青光眼或类固醇性青光眼，1 只为色素性青光眼。术前中位眼压为 25.8[四分位距（IQR），9.7]mmHg，中位数为 3（IQR，2）种青光眼药物。Kaplan-Meier 估计的中位生存时间为 79 天（95%置信区间，37-121d）。12 个月时的成功率为 24%。14 只眼（37%）发生眼压突然升高至 30mmHg 以上。最高眼压为 68mmHg。眼压峰值出现在手术后 1 周至 8 个月之间。总共，43%眼压升高至>30mmHg 的患者没有症状。在 CyPass 植入后，15 只眼（39%）在中位数为 167（IQR，109）天内需要额外的青光眼手术。
在异质临床人群中进行巩膜下支架置入术会导致眼压突然升高的发生率较高，成功率较低。
