Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL.
Duke Eye Center, Duke University, Durham, NC.
J Glaucoma. 2021 Jan 1;30(1):32-36. doi: 10.1097/IJG.0000000000001674.
The use of nylon wicks with fenestrations in nonvalved aqueous shunt surgery significantly reduces intraocular pressure (IOP) and glaucoma medication usage in the immediate postoperative period compared with the use of fenestrations alone.
To compare early postoperative IOP and medication usage in patients undergoing implantation of a nonvalved aqueous shunt device with fenestrations only or fenestrations with nylon wicks.
A retrospective review of all nonvalved aqueous shunt insertions completed by one surgeon (L.W.H.) was completed using current procedure terminology. Patients undergoing Baerveldt or ClearPath 350 mm2 aqueous shunt insertion with fenestrations only (n=37) or fenestrations with 2 nylon wicks were identified (n=92). All devices were ligated with 7-0 Vicryl (polyglactin) suture, and either 4 fenestrations or 2 fenestrations and two 9-0 nylon wicks were placed anterior to the ligature. Data regarding visual acuity (VA), IOP, number of glaucoma medications, and complications were collected from the preoperative visit just before surgery, postoperative day 1, week 3 (POW3), week 5, and month 2 (POM2). The main outcome measures were VA, IOP, number of glaucoma medications, and complications at all postoperative time points.
There was no difference in logMAR VA between the 2 groups at any time point. At POW3, IOP was significantly lower in the wick group (14.6±7.7 vs. 18.1±8.7 mm Hg, P=0.03). Number of glaucoma medications used was significantly reduced in the wick group at POW3 (0.5±0.9 vs. 1.0±1.2, P=0.02) and POM2 (0.7±1.0 vs. 1.4±1.3, P=0.02). There was no significant increase in the overall rate of complications in the wick group, but there was a higher rate of transient hyphema (28% vs. 8%, P=0.02).
The use of 2 nylon wicks with fenestrations in nonvalved aqueous shunt device implantation can significantly lower IOP and medication burden while awaiting the dissolution of the ligature suture.
在非阀门水引流手术中使用带有孔的尼龙导丝，与仅使用孔相比，可显著降低术后即刻的眼内压（IOP）和青光眼药物使用量。
比较在植入非阀门水引流装置时，仅使用孔或使用孔和尼龙导丝的患者的术后早期 IOP 和药物使用情况。
使用当前操作术语，对一位外科医生（L.W.H.）完成的所有非阀门水引流植入手术进行回顾性回顾。确定仅使用孔（n=37）或使用孔和 2 根尼龙导丝（n=92）的 Baerveldt 或 ClearPath 350mm2 水引流植入患者。所有装置均用 7-0 Vicryl（聚乳酸）缝线结扎，并在前结扎处放置 4 个孔或 2 个孔和 2 个 9-0 尼龙导丝。从术前就诊时、术后第 1 天（POW1）、第 3 周（POW3）、第 5 周和第 2 个月（POM2）收集视力（VA）、IOP、青光眼药物数量和并发症相关数据。主要观察指标为所有术后时间点的 VA、IOP、青光眼药物数量和并发症。
两组在任何时间点的 logMAR VA 均无差异。在 POW3，导丝组的 IOP 明显更低（14.6±7.7 vs. 18.1±8.7mmHg，P=0.03）。在 POW3 和 POM2，导丝组使用的青光眼药物数量明显减少（0.5±0.9 vs. 1.0±1.2，P=0.02；0.7±1.0 vs. 1.4±1.3，P=0.02）。导丝组的总体并发症发生率没有显著增加，但暂时性前房积血的发生率较高（28% vs. 8%，P=0.02）。
在非阀门水引流装置植入中使用 2 根带有孔的尼龙导丝可显著降低 IOP 和药物负担，同时等待结扎缝线溶解。
