Bedar Mohammad Seleman, Kellner Ulrich
AugenZentrum Siegburg, MVZ Augenärztliches Diagnostik & Therapiecentrum Siegburg GmbH, Europaplatz 3, 53721, Siegburg, Deutschland.
RetinaScience, Bonn, Deutschland.
Ophthalmologe. 2021 Nov;118(11):1128-1133. doi: 10.1007/s00347-020-01265-5. Epub 2020 Nov 24.
Recurrent treatment with intravitreal anti-VEGF (vascular endothelial growth factor) administration can in rare cases lead to secondary glaucoma that is difficult to adjust. The goal of this case series was to analyze the treatment results of the XEN® gel stent in combination with mitomycin C.
The long-term follow-up over a period of 18 months was evaluated for 3 eyes in 3 patients that underwent treatment with a XEN® gel stent in combination with mitomycin C as a surgical procedure to reduce intraocular pressure.
The eyes had a baseline pressure of 21-31 mm Hg with 3-5 antiglaucoma medications following 15-25 intravitreal injections. In all 3 eyes a pressure drop of almost 50% to 9-14 mm Hg could be achieved after 18 months with complete discontinuation of all local and systemic medications to reduce intraocular pressure in 2 of the 3 eyes. In 1 eye a choroidal detachment occurred for 2 weeks postoperatively. In another eye a surgical revision of conjunctival penetration was carried out. In two eyes needling was necessary due to scarring. In 2 out of 3 eyes, further intravitreal treatment (9 and 13 respectively) was necessary due to the macular disease but no further increase in intraocular pressure occurred.
The XEN® gel stent in combination with mitomycin C is a therapeutic option for difficult to adjust secondary glaucoma following intravitreal anti-VEGF therapy. A continuation of intravitreal anti-VEGF therapy did not lead to a recurrent increase of intraocular pressure.
玻璃体内注射抗血管内皮生长因子（VEGF）进行反复治疗在极少数情况下可导致难以控制的继发性青光眼。本病例系列的目的是分析XEN®凝胶支架联合丝裂霉素C的治疗效果。
对3例患者的3只眼睛进行了为期18个月的长期随访，这些患者接受了XEN®凝胶支架联合丝裂霉素C的手术治疗以降低眼压。
这些眼睛在接受15 - 25次玻璃体内注射后，基线眼压为21 - 31 mmHg，使用3 - 5种抗青光眼药物。18个月后，所有3只眼睛的眼压均下降了近50%，降至9 - 14 mmHg，其中2只眼睛完全停用了所有局部和全身降眼压药物。1只眼睛术后发生脉络膜脱离2周。另1只眼睛进行了结膜穿透的手术修复。2只眼睛因瘢痕形成需要针刺治疗。3只眼睛中有2只因黄斑疾病需要进一步进行玻璃体内治疗（分别为9次和13次），但眼压未进一步升高。
XEN®凝胶支架联合丝裂霉素C是玻璃体内抗VEGF治疗后难以控制的继发性青光眼的一种治疗选择。继续进行玻璃体内抗VEGF治疗并未导致眼压反复升高。
