Department of Ophthalmology, PHHYKY, Lahti, Finland.
Eur J Ophthalmol. 2022 Jan;32(1):709-711. doi: 10.1177/1120672120969040. Epub 2020 Nov 4.
To describe a novel surgical treatment option for managing a symptomatic filtration bleb extending into the three quadrants with adequate IOP control after Xen gel stent implantation.
A 62-year-old female with pseudoexfoliative glaucoma with an IOP of 34 mmHg underwent implantation of a Xen to reduce the IOP in her right eye. The IOP responded well to the procedure, but the patient developed a persistent giant filtration bleb with foreign body sensation and pain. A huge filtering bleb of over 180° after Xen implant surgery was managed by splitting the giant bleb into two parts, posterior dissection into the intermuscular space, a biodegradable collagen device implantation, and suturing the conjunctiva in two parts with absorbable and nonabsorbable sutures.
Before the operation for treatment of a giant bleb, the patient had an IOP of 12 mmHg, a best-corrected visual acuity (BCVA) of 20/40, corneal dellen, and no antiglaucoma medication. Following the bleb recession procedure, the IOP was 16 mmHg, BCVA improved to 20/20, there were no corneal dellen and the patient reported resolution of her bleb discomfort. The IOP and BCVA remained stable through 18 months of follow-up and no antiglaucoma medications or additional surgical procedures were required.
The novel technique described here can be one option to treat this rare (over 180°) bleb formation after Xen Gel Stent implantation without adversely affecting IOP control.
描述一种新的手术治疗方案，用于治疗在 Xen 凝胶支架植入后眼压控制良好的情况下延伸至三个象限的有症状滤过泡。
一名 62 岁女性，患有假性剥脱性青光眼，眼压为 34mmHg，右眼行 Xen 植入术以降低眼压。该手术对眼压反应良好，但患者出现持续的巨大滤过泡，伴有异物感和疼痛。在 Xen 植入手术后，一个超过 180°的巨大滤过泡通过将巨大滤过泡分成两部分、将后部分离到肌间间隙、植入可生物降解胶原装置以及用可吸收和不可吸收缝线将结膜缝合两部分来处理。
在治疗巨大滤过泡的手术前，患者眼压为 12mmHg，最佳矫正视力（BCVA）为 20/40，角膜水肿，无需抗青光眼药物。在滤过泡退缩手术后，眼压为 16mmHg，BCVA 提高到 20/20，角膜无水肿，患者报告滤过泡不适缓解。在 18 个月的随访中，眼压和 BCVA 保持稳定，无需使用抗青光眼药物或进行其他手术。
这里描述的新技术可以作为治疗 Xen 凝胶支架植入后罕见（超过 180°）滤过泡形成的一种选择，而不会对眼压控制产生不利影响。
