Harris James M, Solá-Del Valle David
Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, 260 Longwood Ave, Boston, MA, 02115, USA.
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA.
Am J Ophthalmol Case Rep. 2020 Sep 28;20:100947. doi: 10.1016/j.ajoc.2020.100947. eCollection 2020 Dec.
To provide the first report of effective use of bilateral XEN Gel Stent implantation using an ab externo open-conjunctival approach designed to improve bleb function and meet the uniquely low intraocular pressure requirements of a Japanese patient with normal-tension glaucoma refractory to topical medical therapy.
A 54-year-old phakic Japanese woman with severe normal-tension glaucoma on maximally tolerated medical therapy of four topical agents presented with above-goal intraocular pressures and new medication intolerances. She underwent bilateral ab externo open-conjunctival XEN Gel Stent implantation with tenectomy and sub-Tenon's injection of 40μg of mitomycin-C, which resulted in reduction of intraocular pressures by 41.2 and 28.6% to 10 and 10 mmHg in the right and left eyes, respectively at the most recent visit. Postoperatively, a diffuse filtering bleb with good morphology developed in both eyes. The procedure has so far allowed for complete cessation of all four topical medications for up to eight months following surgery without any serious complications.
This case illustrates the potential of Xen Gel Stent implantation through an ab externo, open-conjunctival approach to be an effective, simple alternative to trabeculectomy to meet the unique low-pressure requirements of normal-tension glaucoma patients with practical and safety benefits of a micro-invasive approach.
首次报告采用经外眦开放结膜入路双侧植入XEN凝胶支架的有效应用情况，该方法旨在改善滤过泡功能，并满足一名对局部药物治疗无效的日本正常眼压性青光眼患者独特的低眼压需求。
一名54岁的有晶状体日本女性，患有严重的正常眼压性青光眼，正在接受四种局部药物的最大耐受治疗，但眼压仍高于目标值，且出现了新的药物不耐受情况。她接受了双侧经外眦开放结膜XEN凝胶支架植入术，并进行了腱膜切除术和在Tenon囊下注射40μg丝裂霉素-C，在最近一次随访时，右眼和左眼眼压分别降低了41.2%和28.6%，降至10 mmHg。术后，双眼均形成了形态良好的弥漫性滤过泡。迄今为止，该手术使得术后长达8个月完全停用了所有四种局部药物，且未出现任何严重并发症。
该病例表明，通过经外眦开放结膜入路植入XEN凝胶支架有可能成为小梁切除术的一种有效、简单的替代方法，以满足正常眼压性青光眼患者独特的低压需求，并具有微创方法的实际和安全优势。
