Kerr Nathan M, Lim Samantha, Simos Maria, Ward Trevor
Centre for Eye Research Australia, Melbourne, Australia; Royal Victorian Eye and Ear Hospital, Melbourne, Australia; Eye Surgery Associates, Melbourne, Australia.
Eye Surgery Associates, Melbourne, Australia.
Ophthalmol Glaucoma. 2021 Nov-Dec;4(6):581-588. doi: 10.1016/j.ogla.2021.02.004. Epub 2021 Mar 8.
To evaluate the effect of primary needling at the time of ab interno gelatin microstent insertion on postoperative needling rates.
Retrospective, interventional cohort study.
Eighty-six eyes of 74 patients with no prior incisional surgery.
Consecutive eyes with open-angle glaucoma refractory to medical treatment that underwent ab interno gelatin microstent insertion (XEN; Allergan Inc.) with or without primary needling.
Primary outcome measure was the proportion of eyes requiring postoperative needling. Secondary outcome measures included the mean reduction in intraocular pressure (IOP), topical glaucoma medication use, complications, reoperations, and number of follow-up clinic visits over 12 months.
Fifty-one eyes (42 patients, median age 74 years) underwent XEN surgery with primary needling at the time of surgery, and 35 eyes (32 patients, median age 73 years) underwent XEN surgery without routine primary needling. Eyes that received routine primary needling had an 84.8% lower rate of postoperative needling (3.9% vs. 25.7%, P = 0.003) and required fewer postoperative clinic visits (P = 0.043). Median IOP was 18.0 mmHg (interquartile range [IQR], 13.0-23.0) on 3.0 (IQR, 2.0-3.0) classes of topical medications at baseline. At 12 months, the median IOP was 11.0 mmHg (IQR, 9.0-14.0) in the primary needling group and 11 mmHg (IQR, 10.0-14.0) when primary needling was not routinely performed. Both groups demonstrated a high safety profile. In total, 5 eyes required further glaucoma surgery with insertion of a glaucoma drainage device.
Primary needling at the time of XEN gel stent insertion is associated with a significant reduction in the need for postoperative needling and postoperative clinic visits. This modification provides a predictable postoperative course with a significant and sustained reduction in both IOP and glaucoma medication requirements with less intense postoperative management.
评估内路植入明胶微支架时进行初次针刺对术后针刺率的影响。
回顾性干预队列研究。
74例未曾接受过切开手术患者的86只眼。
对药物治疗无效的开角型青光眼患者的连续患眼进行内路明胶微支架植入术（XEN；艾尔建公司），部分患者在手术时进行或未进行初次针刺。
主要观察指标为术后需要针刺的眼的比例。次要观察指标包括眼压（IOP）的平均降低幅度、局部青光眼药物的使用情况、并发症、再次手术情况以及12个月内的随访门诊就诊次数。
51只眼（42例患者，中位年龄74岁）在手术时接受了XEN手术并进行了初次针刺，35只眼（32例患者，中位年龄73岁）接受了XEN手术但未进行常规初次针刺。接受常规初次针刺的眼术后针刺率降低了84.8%（3.9%对25.7%，P = 0.003），且术后门诊就诊次数更少（P = 0.043）。基线时，在3.0（四分位间距[IQR]，2.0 - 3.0）类局部药物治疗下，中位眼压为18.0 mmHg（IQR，13.0 - 23.0）。12个月时，初次针刺组的中位眼压为11.0 mmHg（IQR，9.0 - 14.0），未常规进行初次针刺时为11 mmHg（IQR，10.0 - 14.0）。两组均显示出较高的安全性。总共有5只眼需要进一步进行青光眼手术并植入青光眼引流装置。
XEN凝胶支架植入时进行初次针刺与术后针刺需求和术后门诊就诊次数的显著减少相关。这种改良提供了可预测的术后病程，眼压和青光眼药物需求均显著且持续降低，同时术后管理强度降低。
